Therapeutic management options for stage III non-small cell lung cancer

Abstract

Lung cancer is the leading cause of cancer death worldwide. Majority of newly diagnosed lung cancers are non-small cell lung cancer (NSCLC), of which up to half are considered locally advanced at the time of diagnosis. Patients with locally advanced stage III NSCLC consists of a heterogeneous population, making management for these patients complex. Surgery has long been the preferred local treatment for patients with resectable disease. For select patients, multi-modality therapy involving systemic and radiation therapies in addition to surgery improves treatment outcomes compared to surgery alone. For patients with unresectable disease, concurrent chemoradiation is the preferred treatment. More recently, research into different chemotherapy agents, targeted therapies, radiation fractionation schedules, intensity-modulated radiotherapy, and proton therapy have shown promise to improve treatment outcomes and quality of life. The array of treatment approaches for locally advanced NSCLC is large and constantly evolving. An updated review of past and current literature for the roles of surgery, chemotherapeutic agents, radiation therapy, and targeted therapy for stage III NSCLC patients are presented.

Robotic assisted lobectomy for locally advanced lung cancer

“…Surgery continues to play a central role a select group of stage III NSCLC patients who disease is associated with good prognostic factors. These prognostic factors that predict improved outcomes for surgery patients included limited station mediastinal lymph node disease, response to induction therapy, no comorbidity (33). When patients with stage III NSCLC are found to have good prognostic factors and are consider candidates for surgical resection, a minimally invasive surgical approach has shown to offer favourable outcomes (34).…”

PACIFIC trial: new perspectives for immunotherapy in lung cancer

“…PFS in the placebo group was 5.6 months (95% CI, 4.6-7.8); it seems to be worse than expected and reported in other clinical trials in the same setting (2). The reason for this discrepancy remains unclear, because baseline characteristics of patients were well balanced in the two groups and inclusion criteria were definitively comparable with other trials.…”

“…Lung cancer still represents the most frequent cause of cancer-related mortality worldwide and 85% of all lung neoplastic disease are classified as non-small-cell lung cancer (NSCLC) (1); approximately one third of NSCLC are locally advanced disease at diagnosis (2). Actually, the standard-of-care for unresectable or inoperable stage IIIA and IIIB disease for patients with good performance status consists of platinum-based doublet chemotherapy (CT) concurrent with 60 Gy of radiotherapy (RT) administered daily over 6 weeks followed by possible further two cycles of consolidative CT (2).…”

“…Actually, the standard-of-care for unresectable or inoperable stage IIIA and IIIB disease for patients with good performance status consists of platinum-based doublet chemotherapy (CT) concurrent with 60 Gy of radiotherapy (RT) administered daily over 6 weeks followed by possible further two cycles of consolidative CT (2). The supportive evidence for the use of concomitant chemoradiotherapy (CT/RT) is rooted in many clinical trials, with evidence of better results of concurrent CT/RT compared to either modality of administration of CT and RT, alone or sequential (3).…”

Diagnostic and Prognostic Potential of Circulating Long Non-Coding RNAs in Non Small Cell Lung Cancer

“…In these patients, radiotherapy is especially critical [88,89]. Radioactive rays could lead to physical, chemical and biological damages to both tumor cells and normal cells [90].…”