For treatment of locally advanced unresectable tumor
Radiation therapy alone, administered sequentially or concurrently with chemotherapy, may provide benefit to patients with locally advanced unresectable stage III NSCLC. However, combination chemoradiation therapy delivered concurrently provides the greatest benefit in survival with increase in toxic effects.
Radiation therapy with traditional dose and fractionation schedules (1.8 Gy-2.0 Gy per fraction per day to 60 Gy-70 Gy in 6-7 weeks) results in reproducible long-term survival benefit in 5% to 10% of patients and significant palliation of symptoms.
- One prospective randomized clinical study showed the following:
- Radiation therapy given as three daily fractions improved OS compared with radiation therapy given as one daily fraction.[Level of evidence: 1iiA]
- Patterns of failure for patients treated with radiation therapy alone included both locoregional and distant failures.
For palliative treatment
Radiation therapy may be effective in palliating symptomatic local involvement with NSCLC, such as the following:
- Tracheal, esophageal, or bronchial compression.
- Vocal cord paralysis.
- Superior vena cava syndrome.
In some cases, endobronchial laser therapy and/or brachytherapy has been used to alleviate proximal obstructing lesions.
- A systematic review identified six randomized trials of high-dose rate brachytherapy (HDREB) alone or with external-beam radiation therapy (EBRT) or laser therapy.
- Better overall symptom palliation and fewer retreatments were required in previously untreated patients using EBRT alone.[Level of evidence: 1iiC]
- HDREB provided palliation of symptomatic patients with recurrent endobronchial obstruction previously treated by EBRT, when it was technically feasible.
- Although EBRT is frequently prescribed for symptom palliation, there is no consensus about when the fractionation scheme should be used.
- Although different multifraction regimens appear to provide similar symptom relief, [16,17,18,19,20,21] single-fraction radiation may be insufficient for symptom relief compared with hypofractionated or standard regimens, as shown in the NCIC Clinical Trials' Group trial NCT00003685.[Level of evidence: 1iiC]
- Evidence of a modest increase in survival in patients with better PS given high-dose radiation therapy is available.[16,17][Level of evidence: 1iiA]
Patients with stage IIIB disease with poor PS are candidates for chest radiation therapy to palliate pulmonary symptoms (e.g., cough, shortness of breath, hemoptysis, or pain).[Level of evidence: 3iiiC] (Refer to the PDQ summaries on Cardiopulmonary Syndromes and Pain for more information.)
Treatment Options Under Clinical Evaluation
Because of the poor overall results, patients with stage IIIB NSCLC are candidates for clinical trials, which may lead to improvement in the control of disease.
Treatment options under clinical evaluation for stage IIIB NSCLC include the following:
- New fractionation schedules.
- Combined modality approaches.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIIB non-small cell lung cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.