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Management of stage III non-small cell lung cancer

Authors
Steven E Schild, MD
Suresh S Ramalingam, MD
Eric Vallières, MD, FRCSC
Section Editors
Rogerio C Lilenbaum, MD, FACP
Joseph S Friedberg, MD
James R Jett, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Development of a treatment plan for a patient with lung cancer depends upon the cell type (small cell versus non-small cell), an assessment of the patient's overall medical condition, and the tumor stage.

Stage III non-small cell lung cancer (NSCLC) includes a highly heterogeneous group of patients with differences in the extent and localization of disease. Many aspects of the treatment of stage III disease are controversial. Unfortunately, the data supporting treatment approaches in specific patient subsets are often subject to a number of limitations, for example that the trials involved heterogeneous patient populations; the definition of stage III disease has changed over time; and early studies were frequently inadequately powered to detect small differences in therapeutic outcome, were not randomized, or had limited duration of follow-up. Major improvements in therapy, including the use of more active chemotherapy agents and refinements in radiation and surgical techniques, also limit the interpretation of earlier clinical trials. Finally, improvements in pretreatment staging have led to reclassification of patients with relatively minimal metastatic disease as stage IV rather than stage III, leading to a prolonging in the apparent overall survival of both stage III and IV patients [1].

Taking these study limitations into consideration, the treatment approach for stage III disease presented here is consistent with guidelines from the American Society for Radiation Oncology (ASTRO) [2,3], which have been endorsed by American Society of Clinical Oncology (ASCO) [4].

The initial approach to staging of NSCLC and its implications for prognosis are discussed separately. (See "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Tumor, Node, Metastasis (TNM) staging system for lung cancer".)

The management of malignant effusions (classified as stage IV disease in the seventh and eighth editions of the Tumor, Node, Metastasis [TNM] staging system) and the systemic treatment of advanced disease are discussed separately. (See "Management of malignant pleural effusions" and "Pericardial disease associated with malignancy" and "Overview of the treatment of advanced non-small cell lung cancer".)

                             

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Literature review current through: Jun 2017. | This topic last updated: Apr 05, 2017.
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