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doi:10.1378/chest.07-1380
(Chest. 2007; 132:266S-276)
© 2007 American College of Chest Physicians
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Treatment of Non-small Cell Lung Cancer, Stage IIIB*

ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)

James R. Jett, MD, FCCP; Steven E. Schild, MD; Robert L. Keith, MD, FCCP and Kenneth A. Kesler, MD, FCCP

* From the Division of Pulmonary Medicine and Medical Oncology (Dr. Jett), Mayo Clinic, Rochester, MN; the Department of Radiation Oncology (Dr. Schild), Mayo Clinic, Scottsdale, AZ; the Division of Pulmonary Sciences and Critical Care Medicine (Dr. Keith), Denver VA Medical Center, University of Colorado Health Sciences Center, Denver, CO; and the Division of Thoracic Surgery (Dr. Kesler), Indiana University, School of Medicine, Indianapolis, IN.

Correspondence to: James R. Jett, MD, FCCP, Division of Pulmonary Medicine and Medical Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: JETT.JAMES{at}mayo.edu

Objective: To develop evidence-based guidelines on best available treatment options for patients with stage IIIB non-small cell lung cancer (NSCLC).

Methods: A review was conducted of published English-language (abstract or full text) phase II or phase III trials and guidelines from other organizations that address management of the various categories of stage IIIB disease. The literature search was provided by the Duke University Center for Clinical Health Policy Research and supplemented by any additional studies known by the authors.

Results: Surgery may be indicated for carefully selected patients with T4N0-1M0. Patients with N3 nodal involvement are not considered to be surgical candidates. For individuals with unresectable disease, good performance score, and minimal weight loss, treatment with combined chemoradiotherapy results in better survival than radiotherapy (RT) alone. Concurrent chemoradiotherapy seems to be associated with improved survival compared with sequential chemoradiotherapy. Multiple daily fractions of RT when combined with chemotherapy have not been shown to result in improved survival compared with standard once-daily RT combined with chemotherapy. The optimal chemotherapy agents and the number of cycles of treatment to combine with RT are uncertain.

Conclusion: Prospective trials are needed to answer important questions, such as the role of induction therapy in patients with potentially resectable stage IIIB disease. Future trials are needed to answer the questions of optimal chemotherapy agents and radiation fractionation schedule. The role of targeted novel agents in combination with chemoradiotherapy is just starting to be investigated.

Key Words: chemoradiotherapy • hyperfractionated radiotherapy • radiotherapy • treatment stage IIIB






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