Current Update on the Management of Locally Advanced Non-small Cell Lung Cancer

ABSTRACT

Locally advanced NSCLC is a heterogenous group of bronchogenic malignancies that are traditionally thought to be unresectable without overt distant metastasis or malignant pleural effusion. The mainstay of treatment for this class of diseases until the early 1990s was radiation alone, which resulted in a dismal outcome. The new technologies in radiation therapy (e.g. 3D-CRT) and the shift in paradigm (e.g. omission of ENI) have enabled the dose-escalation, which translated to improved outcome compared to the conventional radiotherapy using 2-D planning. The trials combining chemotherapy with radiotherapy, first sequentially, then concurrently, have changed the standard of care for patients with good functional status to concurrent chemoradiation. Some studies have shown survival benefits to adding consolidative systemic therapy with concurrent chemoradiation. We will outline the development of the current treatment standard of locally advanced NSCLC and present selected topics undergoing active research to forecast the next generation of NSCLC therapy