Thoracic oncology practice is changing with the end of the century. New diagnostic tools like photodetection allow to diagnose at a white light undetectable level. Preneoplastic lesions or very early cancers that can be locally treated by photochemotherapy, cryotherapy or brachytherapy. The natural history of lung cancer will also be better known. Concerning advanced disease, cisplatin chemotherapy improves survival of patients with stage III non-small cell lung cancer in combination with surgery or chest irradiation and of those with stage IV in comparison with best supportive care alone. New approaches in small cell lung cancer seem promising like accelerated chemotherapy, early chest radiotherapy and maintenance treatment. Moreover, a series of new active cytotoxic agents has been recently identified. The complexity of these modalities makes more and more necessary a integrated pluridisciplinary approach of the lung cancer patient.
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