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World J Respirol. Jul 28, 2015; 5(2): 140-151
Published online Jul 28, 2015. doi: 10.5320/wjr.v5.i2.140
Unresectable stage III non-small-cell lung cancer: Have we made any progress?
Carolien De Tollenaere, Yolande Lievens, Katrien Vandecasteele, Karim Vermaelen, Veerle Surmont
Carolien De Tollenaere, Karim Vermaelen, Veerle Surmont, Department of Respiratory Medicine, University Hospital of Ghent, 9000 Ghent, Belgium
Yolande Lievens, Katrien Vandecasteele, Department of Radiotherapy, University Hospital of Ghent, 9000 Ghent, Belgium
Author contributions: All the authors equally contributed to this work.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carolien De Tollenaere, MD, Department of Respiratory Medicine, University Hospital of Ghent, De Pintelaan 185, 9000 Ghent, Belgium. carolien.detollenaere@telenet.be
Telephone: +32-14-247276 Fax: +32-14-247276
Received: November 27, 2014
Peer-review started: November 28, 2014
First decision: December 12, 2014
Revised: March 27, 2015
Accepted: June 4, 2015
Article in press: June 8, 2015
Published online: July 28, 2015
Processing time: 249 Days and 9 Hours
Abstract

Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage IIIA or stage IIIB disease. The standard of care for locally advanced disease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage III non-small-cell lung cancer (NSCLC) remains poor. Improving outcomes for patients with unresectable stage III NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.

Keywords: Stage III non-small-cell lung carcinoma; Chemoradiotherapy; Induction chemotherapy; Molecular targeted therapy; Consolidation chemotherapy; Dose-escalation; Altered fractionation; Advanced radiotherapy techniques; Prophylactic cranial irradiation

Core tip: Lung cancer is responsible for the most cancer deaths. One third of patients have unresectable stage IIIA/IIIB disease. Despite a lot of efforts, local control and survival of these patients remains poor. Improving the treatment is therefore one of the biggest challenges in respiratory oncology. This review gives an overview of the important clinical studies that were performed the last decade in the treatment of unresectable stage III non-small-cell lung carcinoma and focuses on improvement of systemic therapy, with the exciting area of implementation of newer agents (targeted therapy and immunotherapy) and improvement of radiotherapy, including the potential of prophylactic cranial irradiation.