Stage III Non-Small Cell Lung Cancer

For patients with suspected stage III NSCLC, an evaluation to exclude metastatic disease should include, at a minimum: history and physical exam and computed tomography (CT) scan of chest and upper abdomen (with contrast, unless contraindicated).

Following evaluation with CT scan as per Recommendation 1.1, fluorodeoxyglucose positron emission tomography (FDG PET) with CT scan and brain imaging should be performed.

For patients who require pathologic assessment of lymph node status, endoscopic techniques should be offered as the initial staging modality.

For patients who require pathologic assessment of lymph node status but for whom endoscopic staging is either unavailable or inconclusive, surgical confirmation of mediastinal stage should be performed.

For patients who have suspected or confirmed stage III NSCLC, multidisciplinary discussion should occur prior to the initiation of any treatment plan.

Biopsy should generally be performed from the site that would establish the highest stage when feasible. Potential tissue yield for pathologic analysis and molecular sequencing should also be considered.

Patients who are planned for a multimodality approach incorporating surgery as defined in Recommendation 2.1 should receive systemic neoadjuvant therapy.

For patients with resectable superior sulcus disease, neoadjuvant concurrent chemoradiation should be administered.