title: Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Systematic searches were conducted through MEDLINE, Embase, and the Cochrane Database for Systematic Review up to December 2011, focusing primarily on randomized trials, selected meta-analyses, practice guidelines, and reviews.
  
  
  RESULTS
  For individuals with stage IIIA or IIIB disease, good performance scores, and minimal weight loss, treatment with combined chemoradiotherapy results in better survival than radiotherapy alone. Consolidation chemotherapy or targeted therapy following definitive chemoradiation for stage IIIA is not supported. Neoadjuvant therapy followed by surgery is neither clearly better nor clearly worse than definitive chemoradiation. Most of the arguments made regarding patient selection for neoadjuvant therapy and surgical resection provide evidence for better prognosis but not for a beneficial impact of this treatment strategy; however, weak comparative data suggest a possible role if only lobectomy is needed in a center with a low perioperative mortality rate. The evidence supports routine platinum-based adjuvant chemotherapy following complete resection of stage IIIA lung cancer encountered unexpectedly at surgery. Postoperative radiotherapy improves local control without improving survival.
  
  
  CONCLUSIONS
  Multimodality therapy is preferable in most subsets of patients with stage III lung cancer. Variability in the patients included in randomized trials limits the ability to combine results across studies and thus limits the strength of recommendations in many scenarios. Future trials are needed to investigate the roles of individualized chemotherapy, surgery in particular cohorts or settings, prophylactic cranial radiation, and adaptive radiation.
authors: University of Michigan Comprehensive Cancer Center, Ann Arbor, MI.
authors: Nithya
authors: N
authors: Ramnath
authors: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors: Thomas J
authors: TJ
authors: Dilling
authors: Thoracic Surgery, Maimonides Medical Center, Brooklyn, NY.
authors: Loren J
authors: LJ
authors: Harris
authors: Yale University School of Medicine, New Haven, CT.
authors: Anthony W
authors: AW
authors: Kim
authors: Yale University School of Medicine, New Haven, CT.
authors: Gaetane C
authors: GC
authors: Michaud
authors: University of Southern California, Los Angeles, CA.
authors: Alex A
authors: AA
authors: Balekian
authors: American College of Chest Physicians, Northbrook, IL.
authors: Rebecca
authors: R
authors: Diekemper
authors: Yale University School of Medicine, New Haven, CT.
authors: Frank C
authors: FC
authors: Detterbeck
authors: Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI. Electronic address: darenber@umich.edu.
authors: Douglas A
authors: DA
authors: Arenberg
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D018579:Patient Selection; D017671:Platinum Compounds / Q000627:therapeutic use; D011013:Pneumonectomy; D011379:Prognosis
chemical_list: D017671:Platinum Compounds