Cancer bronchique non à petites cellules localement avancé : quand et comment intégrer chimiothérapie et radiothérapie ?

Despite progress in therapeutic strategies, overall survival of stage III non-small cell lung cancer (NSCLC) is poor. Currently, the standard treatment of unresectable locally advanced NSCLC is concurrent chemoradiotherapy. This strategy is probably beneficial for patients in good performance status, without important co-morbidities and often younger than 70 years. Platinum-based chemotherapy should be administered at cytotoxic doses. Many questions remain debated: The choice of chemotherapy regimen, the benefit of induction and consolidation chemotherapy is not proven, the modalities of radiation in terms of doses, fractionation and the integration of targeted therapies, particularly EGFR inhibitors. The improved results in recent clinical trials appear to be partly linked to better patient selection through optimization of diagnostic imaging. The new radiation modalities should improve results especially in terms of local control. Similarly, the arrival of new therapeutic approaches such as immunotherapy may change the management of these patients.