Management of stage IIIA NSCLC: the role of radiotherapy—a narrative review

Abstract

BackgroundWorldwide, two million patients are newly diagnosed with lung cancer and 1.7 million die of it every year (1). The most relevant risk factor is and remains smoking (2,3). Non-small cell lung cancer (NSCLC) is the most common histology and accounts for up to 85% of lung cancer cases (4). The 8 th edition of the TNM-classification defines stages I to IV, with subgroups to each stage (Table 1) (5). Generally, patients with stage I to III qualify for curative treatment regimens, while stage IV patients undergo palliative treatment-individual exemptions excluded. As symptoms occur late, 20-27% of patients are diagnosed with locally advanced disease (LA-NSCLC-stage III) (6,7). Patients with LA-NSCLC show large variety of primary tumour extent or lymph node (LN) involvement and are all staged as IIIA-C. Especially within stage III N2 disease, the patient collective shows considerable heterogeneity, leading to different treatment options. Main multimodal treatment options are surgery with (neo)adjuvant chemotherapy or neoadjuvant chemoradiotherapy (CRT) or definitive CRT with or without immunotherapy (IT) (8). Nevertheless, overall survival (OS) remains poor for LA-

Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer—A Review

“…Feasible treatment options should be discussed by a multidisciplinary team. In a setting with multiple treatment options, patient preference should play a prominent role in the decision making [ 8 ].…”