The standard of care in unresectable stage IIIA/B non-small cell lung cancer is combined-modality therapy using both chemotherapy and thoracic radiation therapy. Although there is general agreement on this principle, there remain many controversies regarding the optimal combined-modality approach in this patient population. Both induction and concurrent chemoradiotherapy strategies were initially tested, with both approaches improving survival in randomized phase III trials. Several trials have now been completed comparing sequential versus concurrent approaches. There appears to be a modest and consistent advantage to the concurrent approach at the risk of an increase in the rates of acute toxicities, particularly esophagitis and myelosuppression. The concurrent approach used in the phase III trials evaluating the question of sequence has been the use of full-dose systemic chemotherapy rather than a low-dose radio-enhancing strategy. These approaches are distinctly different, and one must recognize this difference when evaluating results from clinical trials. A number of clinical trials have established the use of both induction and consolidation chemotherapy; however, the optimal approach remains unclear. What is clear is that this population of patients needs aggressive therapy directed at achieving locoregional control as well as control of occult micrometastatic disease that is present in the majority of cases. As treatment strategies have become more aggressive, survival outcomes have improved, although the differences have been modest at best, and the risk of severe toxicity has increased. Future aggressive approaches must enhance both locoregional and distant control of occult disease, with acceptable rates of both acute and long-term toxicities.

中文翻译：

---

不可切除的III期非小细胞肺癌的治疗中的化学治疗问题。

不可切除的IIIA / B期非小细胞肺癌的治疗标准是采用化学疗法和胸腔放射疗法的联合疗法。尽管对此原则已达成共识，但在该患者人群中关于最佳组合方式的争议仍然很多。最初测试了诱导疗法和同步放化疗方案，两种方法均提高了随机III期试验的生存率。现在已经完成了一些比较顺序和并行方法的试验。并发方法似乎有适度和一致的优势，但有可能增加急性毒性，特别是食管炎和骨髓抑制率的风险。在III期试验中评估序列问题的同时使用的方法是使用全剂量全身化疗而不是小剂量放射增强策略。这些方法截然不同，在评估临床试验结果时必须认识到这一差异。许多临床试验确定了诱导化疗和巩固化疗的使用。但是，最佳方法仍不清楚。清楚的是，这部分患者需要积极的治疗，以实现局部区域控制以及大多数病例中隐匿性微转移性疾病的控制。随着治疗策略变得更具侵略性，生存结果也有所改善，尽管两者之间的差异最大，严重毒性的风险也增加了。未来的积极方法必须以可接受的急性和长期毒性发生率，加强对隐匿性疾病的局部和远距离控制。