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Lung cancer, part I: radiotherapy and chemotherapy in locally advanced and metastatic non–small cell cancer
Hematol Oncol Clin N Am 18 (2004) xvii – xviii
Preface
Lung cancer, part I: radiotherapy and chemotherapy in locally advanced and metastatic non–small cell lung cancer
Branislav Jeremic, MD, PhD Guest Editor
Lung cancer is one of the major health problems worldwide. A highly prevalent disease, it is the number one cancer killer in both men and women. The vast majority of these patients have locally advanced or metastatic non– small cell lung cancer, in which surgery does not play a major role; only a minority of those diagnosed with locally advanced disease (mostly those at stage IIIA) can expect to undergo surgery. However, most patients do not fare well without radiotherapy or chemotherapy, regardless of the sequence of treatment modalities used. Although a cure does not exist for stage IV (metastatic) non– small cell lung cancer, there is small subset of stage III (locally advanced) patients achieving long-term (5 years) survival. These figures were disappointingly low with radiation therapy alone, but the addition of chemotherapy and newer radiation therapy approaches has made it possible to double the median survival time and triple the 5-year survival rate. Newer drugs and new radiation therapy technologies are offering new hope of further improvements. Regardless of clinical achievements, emphasis has also been placed on a better understanding of the interaction of these two modalities, which would tailor them to conform more to particular patient subgroups by taking into account both tumor characteristics and the pretreatment patient. Particularly in elderly patients, we have been compelled to ask more meaningful questions in clinical research, the answers to which will ultimately benefit them. 0889-8588/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/S0889-8588(03)00173-4
xviii
B. Jeremic / Hematol Oncol Clin N Am 18 (2004) xvii–xviii
The same can be applied to stage IV non –small cell lung cancer. Although nonbelievers in chemotherapy still exist, numerous clinical studies and metaanalyses clearly show that platinum-based chemotherapy offers a small but real advantage over the best supportive care. Here as well, refinements are directed toward the identification of suitable patients for this treatment approach, particularly with ‘‘third generation’’ drugs. However, these efforts not only underline the necessity of a constant clinical battle against locally advanced and metastatic non – small cell lung cancer—they ask for more cooperation between basic and clinical science. Important achievements that have been made in past decades point to joint collaboration, which should create a two-way road of obtaining answers in the right settings. This issue of the Hemotology/Oncology Clinics of North America is devoted to the management of locally advanced and metastatic non – small cell lung cancer. We have tried to identify important issues in this disease and provide the framework for a debate on various aspects on its diagnosis and treatment. I am indebted to the authors for agreeing to contribute to this purpose, and I am privileged to have had leaders in this field as colleagues steaming toward the same goal: constant improvement in the diagnosis and treatment of lung cancer by dedicating our professional lives to the cause. I believe this effort will be worthwhile if you consider this issue as the deep breath we must take before continuing on with that goal. Branislav Jeremic, MD, PhD Department of Radiation Oncology Klinikum rechts der Isar Technical University Munich Ismaninger Strasse 22 81675 Munich, Germany E-mail address: [email protected]
Preface
Lung cancer, part I: radiotherapy and chemotherapy in locally advanced and metastatic non–small cell lung cancer
Branislav Jeremic, MD, PhD Guest Editor
Lung cancer is one of the major health problems worldwide. A highly prevalent disease, it is the number one cancer killer in both men and women. The vast majority of these patients have locally advanced or metastatic non– small cell lung cancer, in which surgery does not play a major role; only a minority of those diagnosed with locally advanced disease (mostly those at stage IIIA) can expect to undergo surgery. However, most patients do not fare well without radiotherapy or chemotherapy, regardless of the sequence of treatment modalities used. Although a cure does not exist for stage IV (metastatic) non– small cell lung cancer, there is small subset of stage III (locally advanced) patients achieving long-term (5 years) survival. These figures were disappointingly low with radiation therapy alone, but the addition of chemotherapy and newer radiation therapy approaches has made it possible to double the median survival time and triple the 5-year survival rate. Newer drugs and new radiation therapy technologies are offering new hope of further improvements. Regardless of clinical achievements, emphasis has also been placed on a better understanding of the interaction of these two modalities, which would tailor them to conform more to particular patient subgroups by taking into account both tumor characteristics and the pretreatment patient. Particularly in elderly patients, we have been compelled to ask more meaningful questions in clinical research, the answers to which will ultimately benefit them. 0889-8588/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/S0889-8588(03)00173-4
xviii
B. Jeremic / Hematol Oncol Clin N Am 18 (2004) xvii–xviii
The same can be applied to stage IV non –small cell lung cancer. Although nonbelievers in chemotherapy still exist, numerous clinical studies and metaanalyses clearly show that platinum-based chemotherapy offers a small but real advantage over the best supportive care. Here as well, refinements are directed toward the identification of suitable patients for this treatment approach, particularly with ‘‘third generation’’ drugs. However, these efforts not only underline the necessity of a constant clinical battle against locally advanced and metastatic non – small cell lung cancer—they ask for more cooperation between basic and clinical science. Important achievements that have been made in past decades point to joint collaboration, which should create a two-way road of obtaining answers in the right settings. This issue of the Hemotology/Oncology Clinics of North America is devoted to the management of locally advanced and metastatic non – small cell lung cancer. We have tried to identify important issues in this disease and provide the framework for a debate on various aspects on its diagnosis and treatment. I am indebted to the authors for agreeing to contribute to this purpose, and I am privileged to have had leaders in this field as colleagues steaming toward the same goal: constant improvement in the diagnosis and treatment of lung cancer by dedicating our professional lives to the cause. I believe this effort will be worthwhile if you consider this issue as the deep breath we must take before continuing on with that goal. Branislav Jeremic, MD, PhD Department of Radiation Oncology Klinikum rechts der Isar Technical University Munich Ismaninger Strasse 22 81675 Munich, Germany E-mail address: [email protected]