The role of radiation therapy and chemotherapy in the management of airway tumors other than small-cell carcinoma and non-small-cell carcinoma

In rare pulmonary tumors, the choice of local and systemic therapy is frequently dictated by the histologic cell type and (generally) by extrapolation from the existing therapeutic literature for that cell type's more common presentation; however, this approach might change. We are in the midst of a new biological and technological era in how approach and treat cancer. In a phase I trial for non-small-cell lung cancer, Hayman et al safely treated with radiation doses as high as 102.9 Gy (to limited volumes) using three-dimensional, conformal radiation [100]. Such techniques facilitate radiation dose escalation for thoracic neoplasms while minimizing normal tissue toxicity, potentially enhancing the therapeutic ratio. Furthermore, the entire human genome has been sequenced recently, and scientists are now in the process of discovering the functions of previously unknown sequences and their protein products. DNA microarrays can be used to analyze small tissue samples for the presence of gene variations or mutations (genotyping), performing the equivalent of several thousand "Southern blot" experiments in only a few days. In the future, patients might receive individually tailored therapy based upon unique molecular-genetic alterations of the tumor.