Treatment of Stage III Non-small Cell Lung Cancer

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

“…For patients with inoperable, locally advanced non-small cell lung cancer (NSCLC) concurrent chemo-radiotherapy represents the standard of care (1). Although concurrent chemotherapy improves survival by approximately 5% at 5 years, it also significantly increases the risk of toxicity (2).…”

Is tumor location an independent prognostic factor in locally advanced non-small cell lung cancer treated with trimodality therapy?

“…The 2013 American College of Chest Physicians (ACCP) guideline categorized the resectability of tumors based on these cN2 statuses, such as infiltrative or discrete nodes type, and recommendations for treatment were made according to the cN2 status (14). In patients with infiltrative cStage III-N2/N3 NSCLC and a performance status of 0-1 who are being considered for curative-intent treatment, a combination of platinum-based chemotherapy and radiotherapy is recommended, while treatment with induction chemotherapy or CRT followed by surgery is not recommended.…”

“…In patients with infiltrative cStage III-N2/N3 NSCLC and a performance status of 0-1 who are being considered for curative-intent treatment, a combination of platinum-based chemotherapy and radiotherapy is recommended, while treatment with induction chemotherapy or CRT followed by surgery is not recommended. For discrete cN2-involved NSCLC identified preoperatively, the ACCP recommends that a treatment plan be made with input from a multidisciplinary team that includes a medical oncologist, radiation oncologist and thoracic surgeon, and they recommend either definitive CRT or induction therapy followed by surgery over either surgery or radiation alone (14).…”

Perspectives on the effect of nodal downstaging and its implication of the role of surgery in stage IIIA (N2) non-small cell lung cancer

“…About 20% of all patients with non-small cell lung cancer (NSCLC) present with stage IIIA N2 disease. These patients have a higher failure rate both loco-regionally and distantly, with an overall 5-year survival rate of 10-40% (1,2). N2 disease presents with a wide range of severity.…”

“…N2 disease presents with a wide range of severity. This has also been schematized as occult nodal disease, discrete nodal disease, and infiltrative nodal disease (1). The first two categories are amenable to surgery, the latter is not, as it is not possible to obtain R0 resection with bulky nodal disease.…”