This E-learning module provides an excellent overview of the clinical management of patients with locally-advanced non-small cell lung cancer (NSCLC). This group of patients is very heterogeneous according to mediastinal lymph node burden.
The objectives of treatment are the local control of thoracic tumour and lymph nodes extension, as well as micro-metastatic disease control. Despite progress in therapeutic strategies, prognosis remains poor. About 30% of NSCLC are locally-advanced, mainly unresectable.
The author starts the presentation giving the historic background, explaining that radiotherapy became standard of care in these patients half a century ago, with radiotherapy schedule used until now in many countries. However, in recent years, the aim of several studies has been to optimise radiotherapy administration in terms of total dose and using new technologies. Furthermore, a number of randomised phase III trials have shown that chemo-radiotherapy is better in terms of survival than radiotherapy alone.
The author provides further analysis of data on concomitant vs. sequential chemo-radiotherapy, discusses which chemotherapy to associate with radiotherapy, induction vs. consolidation chemotherapy, with illustration from clinical studies findings and results of meta-analysis.
An exhaustive section is dedicated to which radiotherapy to use nowadays, with details on techniques and target definition. A further section is devoted to targeted therapies and chemo-radiotherapy with illustration of studies in patients with oncogenic driver, followed by recent approaches in combining immunotherapy and radiotherapy, outcomes and toxicities.
The author provides very clear clinical practice messages about chemo-radiotherapy being the standard treatment for patients with unresectable stage III NSCLC, but only 40% of patients with unresectable stage III NSCLC are eligible for concurrent chemo-radiotherapy. For the other patients, sequential chemo-radiotherapy, chemotherapy or radiotherapy alone are preferable.
At the end of the module, the author discusses the progress in management considering whether it is due to better treatment or better patient selection. He concludes that the overall survival improvement in the past 10 years, can be due to a better selection of patients, the impact of new radiotherapy techniques and better management of chemo-radiotherapy and treatment-related toxicities.
