Conventional thoracic radiotherapy alone has been widely used for many years in patients with locally advanced non–small cell lung cancer (NSCLC). Locally advanced NSCLC is defined here as stage IIIB (T4 or N3) or stage IIIA considered unresectable because of bulky T3 tumors or fixed N2 disease. The main beneficial effect of thoracic radiotherapy is the decrease or prevention of respiratory symptoms. Long-term results obtained, however, have been generally disappointing. One-year and 5-year overall survival rates range from 29% to 58% and from 4% to 10%, respectively.<sup>10 Damstrup L., Poulsen H.S. Review of the curative role of radiotherapy in the treatment of non–small cell lung cancer Lung Cancer 1994 ;  11 : 153-178  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The two main causes of failure are distant dissemination and lack of local control. The latter pattern of failure was considered of less importance until some years ago, but a better definition of local control with the use of thoracic scan and fiberoptic bronchoscopy allowed recognition of the lack of local control as a main cause of failure.<sup>4 Arriagada R., Le Chevalier T., Quoix E. , e al. ASTRO Plenary: Effect of chemotherapy on locally advanced non–small cell lung carcinoma: A randomized study of 353 patients Int J Radiat Oncol Biol Phys 1991 ;  20 : 1183-1189  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Furthermore, two independent randomized trials showed that an improvement in local control obtained by two different approaches may have an impact on overall survival.<sup>29 Saunders M.I., Dische S., Barrett A. , e al. Randomised multicentre trials of CHART vs conventional radiotherapy in head and neck and non small cell lung cancer: An interim report Br J Cancer 1996 ;  73 : 1455-1462

Cliccare qui per andare alla sezione Riferimenti, 31 Schaake-Koning C., Van Den Bogaert W., Dalesio O. , e al. Effects of concomitant cisplatin and radiotherapy on inoperable non–small cell lung cancer N Engl J Med 1992 ;  326 : 524-530  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> On the other hand, the demonstration that cisplatin-based chemotherapy is able to control subclinical metastases adds a third potential tool to improve the overall survival benefit by combining therapies. This article reviews the conventional approach of thoracic radiotherapy alone and then discusses the results of recent randomized trials that could lead to new developments in the multidisciplinary management of these patients.