Treatment of Stage IIIA NSCLC
Presented as a series of important clinical questions about which management remains somewhat unclear, this article provides the evidence base that practitioners may use to guide decision-making. The authors point out that although treatment for NSCLC in general has advanced significantly over the past decade, management of stage IIIA disease specifically has not changed much.
Starting with staging studies, the authors moved on to address the role of multimodality approaches, including surgery and chemoradiation. After a discussion of the variety of regimens that might be selected, they noted that the following factors should be taken into consideration for the individual patient: “histology (pemetrexed is only useful for patients with nonsquamous histology), potential toxicities (eg, kidney injury for cisplatin, neuropathy for paclitaxel), length of treatment (carboplatin/paclitaxel and pemetrexed-containing regimens have always been studied with consolidation cycles, whereas the role of consolidation for cisplatin/etoposide and vinblastine-containing regimens is controversial), and cost (pemetrexed is significantly more expensive).”
Other questions, such as consolidation therapy, radiation dosing, role for surgery after definitive chemoradiation, targeted therapy, immunotherapy, and intensity of follow-up, are also examined.