Combined radiation and chemotherapy for unresectable non-small cell lung carcinoma

The consensus of the previous Workshop was that there is ‘no proven role for chemotherapy in the combined modality treatment of non-small cell lung cancer (NSCLC) and that this whole area of treatment of NSCLC remains a subject of investigation’. The present workshop, in reviewing the role of such treatment in unresectable NSCLC has the benefit of data from numerous recent Phase II studies and, more importantly, data from several mature (follow-up > 2 years) randomised studies of radiotherapy versus combined radiochemotherapy. In three of the Phase III studies based on a platinum combining chemotherapy regimen, a survival advantage was gained for the combination therapy. Three other platinum based regimens and one non-platinum containing regimen did not show a survival advantage. In some of the studies numbers are small and cannot exclude a difference which is small. It is unclear what influence case selection had on the outcome of these studies. This consensus report details the areas of agreement and uncertainty and refers to requirements for clinical trial protocols and acceptable standards for subsequent publication, rather than routine practice. It recommends constraints and directions for future research.