Combined modality therapy for limited inoperable non-small cell lung cancer

Carcinoma of the lung is the leading cause of cancer death in the United States. Approximately one-third of lung cancer patients present with disease that is clinically confined to the hemithorax, but is unrespectible. ''Standard'' therapy in this setting is radiation therapy to the chest, which increases median survivals of treated patients to nine months, versus four months for untreated controls. Recent evidence suggests that simultaneous chemotherapy (CT) with chest irradiation (XRT) may improve local control and delay systemic relapse. In a pilot study, the authors treated nine patients with split-course XRT and 5FU-Oncovin-Mitomycin C (FOMi). Toxicity has been tolerable. Pharyngitis-esophagitis during XRT has been troublesome, but transient. Myelosuppression and nausea have been very mild. All patients with measurable chest tumors achieved >50% reduction in tumor cross-sectional areas. Longer follow-up and more patient accrual is required. However, this combined modality approach seems promising and the CT is less toxic than the Adriamycin-Cisplatin combinations commonly employed