Dr. Jack West, medical oncologist at Swedish Cancer Institute in Seattle, Washington, talks about the right amount of chemotherapy for patients with locally advanced, non-small cell lung cancer. For more information, visit www.swedish.org/lungcancer

As part of the series co-sponsored by GRACE and LUNGevity, challenging cases in lung cancer discussed with multiple experts, here's one on the common but vexing scenario of a patient with mediastinal node-positive (stage IIIA N2) NSCLC. This is among the most controversial clinical settings in lung cancer, as illustrated by the wide range of answers of how the experts in this program would manage the same patient. Some of the experts even note that the way that such a patient would be managed at their center would depend on the people weighing in on the case.

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.

Several weeks ago I had the opportunity to discuss a series of cases of locally advanced NSCLC with a couple of expert colleagues: Dr. George Blumenschein, medical oncologist in the Division of Thoracic & Head/Neck Oncology at MD Anderson Cancer Center in Houston, TX; and Dr. Walter Curran, radiation oncologist who heads the Division of Radiation Oncology at the Winship Cancer Center at Emory University in Atlanta, GA. Dr.

One of the more common approaches to treating stage IIIA NSCLC with N2 lymph nodes (mediastinal, or mid-chest, on the same side as the primary tumor) is chemotherapy or chemoradiation before surgery. For those who recommend induction therapy (treatment before planned resection), there is a pretty even split between those who recommend chemotherapy alone and those who recommend chemo with concurrent radiation. So how do knowledgeable people come to different conclusions, and who is right?

For patients with locally advanced NSCLC, the question of whether to pursue a surgical or a non-surgical approach has a great deal to do with the extent of mediastinal (middle of the chest) lymph node involvement. The mediastinal nodes are shown here: