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Uptodate Reference Title
Management of stage III non-small cell lung cancer
Management of stage III non-small cell lung cancer
The approach above applies to patients who are appropriate candidates for aggressive treatment. Other approaches, including definitive radiation or palliative options, may be appropriate for patients who are frail or are otherwise poor candidates for aggressive treatment, and are discussed in relevant UpToDate topics.
EGFR: epidermal growth factor receptor; PORT: postoperative radiotherapy. * In addition to radiation for positive margins, some UpToDate contributors also offer PORT to a subset of patients found to have N2 disease at surgery who have particularly high-risk features, as follows:
Multistation nodal disease,
Subcarinal involvement for an upper-lobe cancer,
Extracapsular nodal disease in the involved N2 station,
Highest node resected involvement, OR
Inadequate nodal resection at surgery
However, other UpToDate contributors do not offer PORT to those with resected N2 disease, unless margins are positive. ΒΆ Although some UpToDate experts offer definitive chemoradiation to all treatment candidates with stage III N2 disease, others offer induction chemotherapy by surgery to a select subgroup with favorable features, ie, those with all of the following:
Single-station N2 disease that was <3 cm prior to induction therapy
Disease that can be resected via lobectomy rather than pneumonectomy
Disease that responded to induction therapy, as evidenced by radiographic clearance of mediastinal lymph nodes
