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    Non-Small Cell Lung Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IIIA NSCLC Treatment

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    Prognosis:

    Radiation therapy with traditional dose and fractionation schedules (1.8-2.0 Gy per fraction per day to 60-70 Gy in 6-7 weeks) results in reproducible long-term survival benefit in 5% to 10% of patients and significant palliation of symptoms.[19]

    Evidence (radiation therapy for locally advanced unresectable tumor):

    1. One prospective randomized clinical study showed the following:[20]
      • Radiation therapy given continuously (including weekends) as three daily fractions (CHART) improved OS compared with radiation therapy given as one daily fraction.[20][Level of evidence: 1iiA]
      • Patterns of failure for patients treated with radiation therapy alone included both locoregional and distant failures.

    Although patients with unresectable stage IIIA disease may benefit from radiation therapy, long-term outcomes have generally been poor because of local and systemic relapse.

    For palliative treatment

    Radiation therapy may be effective in palliating symptomatic local involvement with NSCLC, such as the following:

    • Tracheal, esophageal, or bronchial compression.
    • Pain.
    • Vocal cord paralysis.
    • Hemoptysis.
    • Superior vena cava syndrome.

    In some cases, endobronchial laser therapy and/or brachytherapy has been used to alleviate proximal obstructing lesions.[21]

    Evidence (radiation therapy for palliative treatment):

    1. A systematic review identified six randomized trials of high-dose rate brachytherapy (HDREB) alone or with external-beam radiation therapy (EBRT) or laser therapy.[22]
      • Better overall symptom palliation and fewer re-treatments were required in previously untreated patients using EBRT alone.[22][Level of evidence: 1iiC]
      • Although EBRT is frequently prescribed for symptom palliation, there is no consensus about when the fractionation scheme should be used.
      • For EBRT, different multifraction regimens appear to provide similar symptom relief;[23,24,25,26,27,28] however, single-fraction radiation therapy may be insufficient for symptom relief compared with hypofractionated or standard regimens, as seen in the NCIC Clinical Trials' Group trial (NCT00003685).[25][Level of evidence: 1iiC]
      • Evidence of a modest increase in survival in patients with better PS given high-dose EBRT is available.[23,24][Level of evidence: 1iiA]
      • HDREB provided palliation of symptomatic patients with recurrent endobronchial obstruction previously treated by EBRT, when it was technically feasible.

    Chemoradiation therapy

    The addition of sequential and concurrent chemotherapy to radiation therapy has been evaluated in prospective randomized trials and meta-analyses. Overall, concurrent treatment may provide the greatest benefit in survival with increase in toxic effects.

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