Locally advanced, or stage III, NSCLC, can potentially include patients for whom surgery is an option, but for many patients with stage IIIA and a majority of those with stage IIIB NSCLC, a non-surgical approach is the best treatment recommendation. It’s important to keep in mind that the goal of treatment for patients with locally advanced NSCLC but who don’t have a malignant pleural effusion (fluid inside the chest but outside of the lung, with cancer cells in it) can potentially be cured. The risk of doing poorly are from both local growth and distant micrometastatic spread (living cancer cells traveling elsewhere in the body through the bloodstream).

The old standard in the 1980s was radiation alone. An important clinical trial the “Dillman Trial” then compared the old standard of just radiation alone to chemo with a two drug combination of “cisplatin-based” chemo for two cycles followed by the same radiation plan. The cure rate was significantly better, although unfortunately we were still curing these patients far too rarely. However, it changed the standard of care from radiation alone to a combination of chemo and radiation together. Continue reading →