Non-Small Cell Lung Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IIIA NSCLC Treatment
Standard Treatment Options for Tumors That Invade the Chest Wall (T3, N0 or N1, M0)
Standard treatment options for tumors that invade the chest wall include the following:
- Surgery and radiation therapy.
- Radiation therapy alone.
- Chemotherapy combined with radiation therapy and/or surgery.
Selected patients with bulky primary tumors that directly invade the chest wall can obtain long-term survival with surgical management provided that their tumor is completely resected. Radical surgery, including chest wall resection, may result in a 5-year survival rate of up to 50%.
Evidence (radical surgery):
- In two small case series of 97 and 104 patients, respectively, the 5-year survival rates of patients who had completely resected T3, N0, M0 disease were 44.2% and 67.3%; for T3, N1, M0 disease 5-year rates were 40.0%, and T3; and for N2, M0 disease 5-year rates were 6.2% and 17.9%.[42,43][Level of evidence: 3iiiDi]
- In a case series of 309 patients treated at three centers, patients who underwent en bloc resection had superior outcomes compared with patients who underwent extrapleural resections (60.3% vs. 39.1%; P = .03).[Level of evidence: 3iiiDi]
Adjuvant chemotherapy is recommended and radiation therapy is reserved for cases with unclear resection margins. Survival rates were lower in patients who underwent incomplete resection and had mediastinal lymph node involvement. Combined modality approaches have been evaluated to improve ability to achieve complete resection.
Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation include the following:
- Combined modality therapy, including chemotherapy, radiation therapy, and surgery in various combinations.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIIA non-small cell lung cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
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