[Chemotherapy in a multidisciplinary approach to the treatment of stage III non-small-cell bronchial cancers (NSCBC)]

Abstract

Radiotherapy and surgery are not the only treatments for non-small cell stage III bronchial cancer (CBNPC) but are elements in an overall strategy used in association with chemotherapy. In resectable forms, chemotherapy can be used only after the operation: 14 randomised trials have been published between 1962 and 1994 which were ultimately joined together in a large meta-analysis. Only chemotherapy containing platinum in the regime appeared to have a beneficial effect which was at the limit of statistical significance, although the effects of chemotherapy were deleterious for those regimes incorporating alkylating agents. The number of published trials associating chemotherapy and post-operative radiotherapy are much fewer. One finds, but in a less clear cut fashion, a deleterious effect of chemotherapy using alkylating agents and a tendency for a non-significant improvement and survival in the arms of studies containing Cisplatine in their regime. Chemotherapy may also be used before an operation and there are many theoretical arguments in favour of this approach. Three published randomised studies have important problems in their design and should be interpreted with caution whilst awaiting the results of several studies which are underway. In the non-resectable forms radiotherapy and chemotherapy may be used in a sequential fashion, simultaneously or rapidly alternating each method of administration have advantages and disadvantages. At least ten randomised trials compare the sequence of chemotherapy-radiotherapy or radiotherapy-chemotherapy or radiotherapy exclusively. Each time chemotherapy comprising platinum was used the trials showed evidence of a significant difference in survival compared to the associated arms. Concomitant radiotherapy and chemotherapy using 5-Fluoro-uracil, VP16 and above all platinum have been the object of several Phase I and Phase II studies. Response levels with platinum. Several randomised studies have compared the association of chemotherapy/radiotherapy concomitantly to exclusive radiotherapy. Their results are divergent. Thus, if many questions remain, it seems established that the association of radiotherapy, in Stage III non-resectable cancer, or of short initial chemotherapy, or of concomitant therapy may be susceptible to improving the survival in a significantly way. Besides, it is probable but not yet demonstrate, that the association of short neoadjuvant chemotherapy to surgery in the resectable forms may equally improve the survival in a significant fashion.