Treatment Of Stage III Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer

Publication Date: November 1, 2013
Last Updated: March 14, 2022

Recommendations

Infiltrative Stage III (N2/N3) Disease

In patients with infiltrative stage III (N2,3) NSCLC and performance status 0-1 being considered for curative-intent treatment, radiotherapy alone is not recommended. (1, A)
307795
In patients with infiltrative stage III (N2,3) NSCLC and performance status 0-1 being considered for curative-intent treatment, combination platinum-based chemotherapy and radiotherapy (60-66 Gy) are recommended. (1, A)
307795

In patients with infiltrative stage III (N2,3) NSCLC, performance status 0-1, and minimal weight loss being considered for curative-intent treatment, concurrent chemoradiotherapy is recommended over sequential chemoradiotherapy.

(1, A)
307795
In patients with infiltrative stage III (N2,3) NSCLC with a complete response after treatment with concurrent chemoradiotherapy, it is suggested that PCI should not be given (outside of a clinical trial). (2, C)
307795
In patients with infiltrative stage III (N2,3) NSCLC and performance status 0-1 being considered for curative-intent treatment, treatment with neoadjuvant (induction) chemotherapy or chemoradiotherapy followed by surgery is not recommended. (1, C)
307795
In patients with infiltrative stage III (N2,3) NSCLC and performance status 2 or those with substantial weight loss (>10%), concurrent chemo radiotherapy is suggested but with careful consideration of the potential risks and benefits. (2, C)
307795
In patients with infiltrative stage III (N2,3) NSCLC, performance status 0-1, and minimal weight loss being considered for curative-intent reatment, a platinum-based doublet chemotherapy is suggested. (2, C)
307795
In patients with symptomatic infiltrative stage III (N2,3) NSCLC and either performance status 3-4, comorbidities, or disease too extensive to treat with curative intent, palliative radiotherapy is recommended. The fractionation pattern should be chosen based on the physician’s judgment and patient’s needs. (1, C)
307795

Discrete Mediastinal Node Involvement

In patients with discrete N2 involvement by NSCLC identified preoperatively (IIIA), it is recommended that the treatment plan should be made with the input from a multidisciplinary team. (1, C)
307795
In patients with discrete N2 involvement by NSCLC identified preoperatively (IIIA), either defi nitive chemoradiation therapy or induction therapy followed by surgery is recommended over either surgery or radiation alone. (1, A)
307795
In patients with discrete N2 involvement by NSCLC identified preoperatively (IIIA), primary surgical resection followed by adjuvant therapy is not recommended (except as part of a clinical trial). (1, C)
307795

Occult N2 Involvement Despite Thorough Preoperative Staging (Stage IIIA)

In patients with NSCLC undergoing surgical resection, systematic mediastinal lymph node sampling or complete MLND is recommended. (1, B)
307795
In patients with NSCLC who have incidental (occult) N2 disease (IIIA) found at surgical resection despite thorough preoperative staging and in whom complete resection of the lymph nodes and primary tumor is technically possible, completion of the planned lung resection and mediastinal lymphadenectomy is suggested. (2, C)
307795
In patients with resected NSCLC (R0) who were found to have incidental (occult) N2 disease (IIIA) despite thorough preoperative staging and who have good performance status, adjuvant platinum-based chemotherapy is recommended. (1, A)
307795
In patients with R0 resected NSCLC who were found to have incidental (occult) N2 disease (IIIA) despite thorough preoperative staging, sequential adjuvant radiotherapy is suggested when concern for a local recurrence is high. (2, C)
307795
In patients with NSCLC who were found to have incidental (occult) N2 disease (IIIA) despite thorough preoperative staging and were incompletely resected (R1,2), combined postoperative concurrent chemotherapy and radiotherapy is suggested. (2, C)
307795

Recommendation Grading

Overview

Title

Treatment Of Stage III Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer

Authoring Organization

Publication Month/Year

November 1, 2013

Last Updated Month/Year

June 26, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Stage III non-small cell lung cancer (NSCLC) describes a heterogeneous population with disease presentation ranging from apparently resectable tumors with occult microscopic nodal metastases to unresectable, bulky nodal disease. This review updates the published clinical trials since the last American College of Chest Physicians guidelines to make treatment recommendations for this controversial subset of patients.

Target Patient Population

Patients with Stage III non-small cell lung cancer

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospice, Hospital, Long term care, Operating and recovery room, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D002289 - Carcinoma, Non-Small-Cell Lung, D008175 - Lung Neoplasms, D016371 - Cranial Irradiation

Keywords

lung cancer, non-small cell lung cancer, radiation therapy, Non Small Cell Lung Cancer, non_small_cell_lung_cancer, Adjuvant Radiation Therapy

Supplemental Methodology Resources

Data Supplement