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.

Keywords: Non-small cell lung cancer, Chemoradiotherapy, Multi-modality, Targeted therapy, Dose-escalation

Core tip: Locally advanced non-small cell lung cancer consists of a heterogeneous population making management challenging. Multiple strategies are being developed to maximize survival and disease control. The role of surgery is being re-evaluated given new insight into the efficacy chemotherapy and radiation. Multi-modality therapy is playing an increasingly important role for both resectable and unresectable stage III patients. Chemoradiation plays a large role in the management of inoperable or unresectable patients. Third generation chemotherapy and other targeted therapies are being incorporated into chemoradiation. Radiation dose-escalation, alternative fractionation schedules, intensity-modulated radiotherapy, and proton therapy are evaluated to improve outcomes from chemoradiation.