Rational integration of radiation and chemotherapy in patients with unresectable stage IIIA or IIIB NSCLC: Results from the Lung Cancer Study Group, Eastern Cooperative Oncology Group, and Radiation Therapy Oncology Group

About 40 percent of all patients diagnosed with non-small-cell lung cancer (NSCLC) have locally advanced stage IIIA or IIIB disease. Such disease is at the borderline of anatomic resectability and associated with poor survival prospects with any present therapy. The Lung Cancer Study Group, Eastern Cooperative Oncology Group, and Radiation Therapy Oncology Group, among other North American clinical cooperative groups, have integrated radiation and chemotherapy in an attempt to prolong survival and, in some cases, cure patients with unresectable NSCLC. These two modalities have been given sequentially, concurrently, and in an alternating fashion with varying degrees of success. Trials employing cisplatin-containing chemotherapy have produced more positive results than those using other regimens, although this is not invariably so. Clearly, better treatments are needed for local and systemic disease. This paper considers possible mechanisms for combining radiation and chemotherapy, reviews the status of recent and current clinical trials, and outlines some directions for future research.