When I was a medical student, the question about lung cancer that was always asked on "the Boards" had to do with the difference between stage IIIA and stage IIIB non-small cell lung cancer (NSCLC). The reason this question was always asked is because patients with stage IIIA NSCLC might be considered for surgery, whereas patients with stage IIIB NSCLC would not be considered for surgery and instead would be treated with chemotherapy and radiation. The idea is that young doctors should be able to make that distinction and to direct patients to the appropriate specialist/treatment.

Here is the third and final case I discussed with two great experts in locally advanced NSCLC. Drs. George Blumenschein, medical oncologist from MD Anderson Cancer Center in Houston, and Wally Curran, radiation oncologist from Winship Cancer Center at Emory University in Atlanta, joined me several weeks ago to discuss a series of challenging cases that illustrate the complexities and array of options in treating patients with stage III NSCLC.

Here is the second case in my expert round table discussion on locally advanced NSCLC with medical oncologist Dr. George Blumenschein froMD Anderson Cancer Center and radiation oncologist Dr. Walter Curran from Emory University.

My friend and colleague, Dr. Ramiswamy Govindan, is one of the national leaders in lung cancer, and he was kind enough to participate in our NSCLC Patient Education Forum. There, he spoke in some general terms about what patients might expect from chemo/radiation for locally advanced lung cancer (which could include limited SCLC as well as stage III NSCLC), but he also used the occasion to talk about general guidelines about where we've come from and where we're going with cancer treatments.

Look, before I begin this post let me say that I’m really not trying to be a negative person when it comes to Avastin (bevacizumab; see here and here). It is a great drug in the appropriate setting, and is has been proven to prolong survival in first-line treatment of advanced NSCLC patients when combined with chemotherapy.

In 2008 the SWOG 0023 trial was published, which looked at the question of maintenance Iressa (gefitinib) after definitive chemoradiation in patients with locally advanced (Stage III) NSCLC. The trial randomized patients who had not progressed after completing CRT with concurrent cisplatin and etoposide chemotherapy followed by consolidation Taxotere (docetaxel) to either Iressa or placebo. Patients were then followed until progression or death.

With special thanks to the support of the Lung Cancer Connection and longtime member and friend of GRACE Myrtle Chidester, I am very happy to offer a new video podcast presentation on one of the most controversial and interesting areas of lung cancer management. Stage IIIA NSCLC with N2 mediastinal node involvement generates debates among the experts as well as at local hospital tumor boards everywhere, on a weekly basis.

“Locally-advanced NSCLC” is a term generally applied to lung cancers with tumors that have either grown into major structures (such as vertebrae or spine bones, the central airways, or involve the main blood vessels supplying the lung or central chest) or those cancers that have spread to lymph nodes in the central chest (the mediastinum). In the case of many of these cancers, removing them with surgery is not possible, but treatment with the combination of chemotherapy and radiation given at the same time may be used with the goal of curing the cancer.

Dr. Suresh Ramalingam is a longtime friend of mine and a national leader in the field of lung cancer. He is the Director of the Lung Cancer Program at the Winship Cancer Institute at Emory University in Atlanta, and he was kind enough to sit down with me to talk about his perspective on the current optimal treatment for patients with stage III, or locally advanced, NSCLC. We also spoke about managing metastatic disease, which will be covered in a separate podcast. It's an audio interview, but if people watch the video version, there are some figures synchronized with the discussion.