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Which Patients with Stage III Non-Small Cell Lung Cancer Should Undergo Surgical Resection?

University of Pennsylvania School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Correspondence: Joseph B. Shrager, M.D., Associate Professor of Surgery, General Thoracic Surgery, 4 Silverstein, HUP, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA. Telephone: 215-662-4767; Fax: 215-614-1861; e-mail: jshrag{at}mail.med.upenn.edu

The treatment of patients with stage III NSCLC remains controversial. Stage III NSCLC comprises a fairly heterogeneous group of tumors, and furthermore only sparse data from randomized clinical trials exist to guide therapy decisions. This review article proposes a management algorithm for patients with stage III NSCLC that is based upon the currently available data on surgical therapy, chemotherapy, and radiation therapy. By necessity, given the paucity of strong data, a good deal of opinion is offered. The choice to proceed with aggressive, combined modality treatment is presented in light of extent of local disease as well as patient performance status.

Key Words. Non-small cell lung carcinoma • Neoadjuvant therapy • Pulmonary surgical procedures • Neoplasm staging