Recent Advances and Dilemmas in the Radiotherapeutic Management of Locally Advanced Non-Small Cell Lung Cancer

During the 1990s, thoracic radiotherapy (RT) combined with chemotherapy was accepted as a “new” gold standard for patients with good performance status locally advanced/inoperable non-small cell lung cancer (NSCLC). This paradigm shift away from RT alone has raised several fundamental questions: What is the optimal sequencing of chemotherapy and radiotherapy? Should standard (once-daily) RT continue to be employed? What about altered fractionation schema? Is there a role for three-dimensional conformal RT? How can the toxicity of combined modality strategies be reduced?