Dr. West reviews basic principles of treating locally advanced lung cancer, including the need to treat both local disease and possible distant disease, and the need to balance efficacy with toxicity.

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?

Here's a text-heavy but still brief summary "slidedoc" of what I would consider to be the core principles of managing locally advanced, or stage III, non-small cell lung cancer (NSCLC). This is a heterogeneous population that accounts for about 40% of the patients newly diagnosed with NSCLC, with some having far more extensive and bulky disease than others.  Though individual treatment recommendations should be made by the physicians directly reviewing the details of a patient's case, the key principles still govern the overall plan.

Dr. David Gerber, University of Texas-Southwestern, reviews a Swiss study comparing tri-modality therapy with chemoradiation followed by surgery to chemo followed by surgery for stage IIIA NSCLC.

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Dr. David Gerber, University of Texas-Southwestern, reviews results of the START trial of tecemotide immunotherapy for stage III unresectable NSCLC.

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Dr. David Gerber, University of Texas-Southwestern, reviews results from RTOG 0617 that help clarify the optimal dose of radiation for stage III unresectable NSCLC.

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Dr. David Gerber, University of Texas-Southwestern, reviews the current questions in managing locally advanced NSCLC with chemo/radiation as introduction to key issues addressed in trials from ASCO 2013.

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The Radiation Therapy Oncology Group (RTOG) has been working on a large randomized trial in patients with stage III, locally advanced, unresectable NSCLC that asked two key questions:

1) is the best dose of radiation the "old" standard of 60 Gray (Gy), over about 6 weeks, or a higher dose of 74 Gy that has been found to be feasible?

2) Is there a value in adding weekly Erbitux (cetuximab), the antibody to the epidermal growth factor receptor (EGFR), along with weekly carboplatin/Taxol (paclitaxel) and concurrent chest radiation therapy (RT)?

Drs. Nate Pennell, Mary Pinder, and Jack West discuss the START trial of L-BLP-25 (tecemotide) immunotherapy in locally advanced NSCLC.

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Dr. Heather Wakelee from Stanford University discusses the open question of whether patients with resectable or locally advanced NSCLC should have testing for molecular markers, as well as how we might use this information in clinical practice.

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