Pattern of failure following chemoradiation for locally advanced non-small cell lung cancer: potential role for stereotactic body radiotherapy.

Standard of care for locally advanced non-small cell lung cancer has been concurrent chemoradiation. However, optimal chemotherapy regimen, radiation therapy dose and treatment volume have not been clearly defined despite 30 years of controlled clinical trials. This review analyzes survival and failure pattern reported from randomized studies of chemoradiation for non-small cell lung cancer. Despite introduction of new chemotherapy agents, survival remained poor; rates of both locoregional failures and distant metastasis remained high. The current radiation dose appears insufficient to reliably establish local control. Stereotactic body radiotherapy may allow radiation dose escalation and should be tested in future clinical trials.