The Many Faces of Stage III NSCLC: Why We Have Such Trouble Nailing Down an Optimal Treatment for Locally Advanced Disease

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There are many open questions in managing lung cancer, but one of our historical areas that has been especially challenging has been locally advanced/stage III NSCLC, which we most commonly treat with at least two different forms of therapy, such as chemotherapy followed by surgery, chemo and radiation followed by surgery, or (most commonly) chemotherapy and radiation without surgery. Why is it such a controversial area?

Introduction to Locally Advanced, Unresectable Stage III NSCLC

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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.

Round Table with Drs. Blumenschein and Curran, Bulky Stage IIIB NSCLC

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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.

Interview with Dr. Suresh Ramalingam: Current Standards and Controversies in Locally Advanced NSCLC

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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.