Prise en charge des CBNPC de stade III : la radiochimiothérapie concomitante

Despite progress in therapeutic strategies, overall survival of stage III non small cell lung cancer (NSCLC) is poor, with 5 year survival of the order of 10 to 15%. Radiotherapy is the cornerstone of treatment in these patients. Today, progress in imagery and new technologies allow a reduction of treatment volume and an escalation of total dose to improve local control and reduce toxicity. Since the early 1990's it has been accepted that the combination of chemotherapy and radiotherapy improves overall survival. Currently, the standard treatment of unresectable, locally advanced NSCLC is concurrent chemo-radiotherapy. This strategy has been confirmed by a recent meta-analysis but at the price of an increase in oesophageal toxicity. This schedule is only possible for patients with good performance status (PS 0-1), without important co-morbidities. Several platinum based chemotherapies have been evaluated concurrently with radiotherapy. The optimal sequencing of concurrent radiotherapy and chemotherapy is not well defined and the impact of induction or consolidation chemotherapy on survival has not been demonstrated. The integration of targeted therapies in the treatment of stage III NSCLC is also under investigation.