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🌱 來自: NSCLC Treatment

Pathologic stage IIIA (N2) to IIIB disease of NSCLC Treatment

• Surgery, rad onc, & med onc consults mandatory for multimodality tx. Sequence of surgery, RT, & chemo varies
• Induction:
  • If resectable, neoadj chemo is best response followed by resection + PORT. Neoadj chemoRT does not improve OS
• Concurrent ChemoRT:
  • If unresectable (multiple +N2 LN >3 cm), definitive concurrent chemoRT (JCO 1999;17:2692), regimens: CIS/peme, CIS/vinblastine, CIS/etoposide, carbo/paclitaxel
• Pancoast tumor:
  • ChemoRT (CIS/etoposide + 45 Gy) followed by surgery (T3N0-1) improves resectability (SWOG 9416, JCO 2007;25:313). If unresectable (T4N0-1), chemoRT
• Adj. checkpoint inhibitor in IIIB unresectable:
  • ↑ OS w/ durvalumab for 1 y after response to plat doublet w/ definitive RT (NEJM 2018;379:2342)
  • Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC