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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2017; 8(1): 1-20
Published online Feb 10, 2017. doi: 10.5306/wjco.v8.i1.1
Therapeutic management options for stage III non-small cell lung cancer
Stephanie M Yoon, Talha Shaikh, Mark Hallman
Stephanie M Yoon, Talha Shaikh, Mark Hallman, Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
Author contributions: The research was conceptualized, performed, and written by Yoon SM, Shaikh T and Hallman M.
Conflict-of-interest statement: The authors disclose no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Talha Shaikh, MD, Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, United States. talha.shaikh@fccc.edu
Telephone: +1-215-7282581 Fax: +1-215-2144038
Received: July 28, 2016
Peer-review started: July 30, 2016
First decision: September 2, 2016
Revised: November 6, 2016
Accepted: December 27, 2016
Article in press: December 28, 2016
Published online: February 10, 2017
Processing time: 195 Days and 10 Hours
Abstract

Lung cancer is the leading cause of cancer death worldwide. Majority of newly diagnosed lung cancers are non-small cell lung cancer (NSCLC), of which up to half are considered locally advanced at the time of diagnosis. Patients with locally advanced stage III NSCLC consists of a heterogeneous population, making management for these patients complex. Surgery has long been the preferred local treatment for patients with resectable disease. For select patients, multi-modality therapy involving systemic and radiation therapies in addition to surgery improves treatment outcomes compared to surgery alone. For patients with unresectable disease, concurrent chemoradiation is the preferred treatment. More recently, research into different chemotherapy agents, targeted therapies, radiation fractionation schedules, intensity-modulated radiotherapy, and proton therapy have shown promise to improve treatment outcomes and quality of life. The array of treatment approaches for locally advanced NSCLC is large and constantly evolving. An updated review of past and current literature for the roles of surgery, chemotherapeutic agents, radiation therapy, and targeted therapy for stage III NSCLC patients are presented.

Keywords: Non-small cell lung cancer; Chemoradiotherapy; Multi-modality; Targeted therapy; Dose-escalation

Core tip: Locally advanced non-small cell lung cancer consists of a heterogeneous population making management challenging. Multiple strategies are being developed to maximize survival and disease control. The role of surgery is being re-evaluated given new insight into the efficacy chemotherapy and radiation. Multi-modality therapy is playing an increasingly important role for both resectable and unresectable stage III patients. Chemoradiation plays a large role in the management of inoperable or unresectable patients. Third generation chemotherapy and other targeted therapies are being incorporated into chemoradiation. Radiation dose-escalation, alternative fractionation schedules, intensity-modulated radiotherapy, and proton therapy are evaluated to improve outcomes from chemoradiation.