Multimodality therapy for stage III NSCLC: Controversies, advances, and evolving approaches

Oliver Gautschi, Zelanna Goldberg, Royce Calhoun, David R Gandara

Research output: Contribution to journalArticle

Abstract

Stage III non-small cell lung cancer (NSCLC) comprises a very heterogenous group of patients with regard to tumor extent, prognosis, and treatment options. Although combined-modality therapy (chemotherapy ± radiotherapy ± surgery) is appropriate in most patient subsets, specific recommendations vary considerably. For example, concurrent chemoradiotherapy paradigms have recently emerged as a standard-of-care for selected patients with unresectable stage III disease (ie, those patients with good performance status, adequate pulmonary function, and low comorbidities). It is important to realize that selection criteria such as these are appropriate in many of the clinical situations described in this article to maximize benefit and reduce the risk of unacceptable toxicities. Of note, this approach does not apply to those patients with stage IIIB disease defined by malignant pleural effusion because this T4 designation characterizes a group of patients incurable with combined-modality therapy. There is no consensus on the treatment of patients with resectable stage III disease. Although surgery is commonly performed in many patient subsets, its role is currently being redefined because of the positive results of adjuvant postoperative chemotherapy and improved efficacy with chemoradiotherapy alone. Novel molecular targeted agents have now shown activity in advanced stage disease, and it is anticipated that ongoing studies will define a role for these agents in the combined-modality therapy of earlier stages. Although the evolution of multimodality therapy in recent years has improved the outlook for patients with locally advanced NSCLC, at present only a minority achieve long-term survival. Further advances will depend on carefully planned and conducted clinical research studies, incorporating the skills and expertise of a wide range of lung cancer specialists, including clinical investigators and basic science collaborators.

Original languageEnglish (US)
JournalAdvanced Studies in Medicine
Volume6
Issue number4 B
StatePublished - Apr 2006

ASJC Scopus subject areas

  • Medicine(all)

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