Define as locoregional advanced disease because of extension of the primary tumor such as a T3 lesion with hilar lymph nodes or a T4 lesion or the involvement of mediastinal lymph nodes (N2 or N3) without evidence of distant metastatic disease.
Represents approximately 25% of non-small cell lung cancers diagnosed each year.
Evaluation of such patients includes a CT scan of the chest and upper abdomen and if the patient is eligible for curative treatment a PET scan is recommended.
Where is mediastinal staging, if there is extensive mediastinal infiltration pathological assessment of the meatiest nine and is not necessary.
In situations where there is discrete mediastinal lymph node enlargement, even in the presence of a positive PET scan histological comfirmation of mediastinal involvement is warranted.
In a patient with a central lung tumor or with an enlarged N1 nodes and who have a normal mediastinum by imaging, histologic confirmation of mediastinum nodes is required, because the presence of occult mediastinal nodal involvement can be as high as 25% despite normally imaging studies.
Histologic confirmation can be achieved through the needle-based techniques such as endoscopic ultrasound for by video assisted mediastinoscopy dependent on resources.
For individuals within large mediastinal lymph nodes on CT scans or PET scan is negative endoscopic bronchial ultrasound should be followed by a surgical biopsy.
Up to 16% of patients with apparently stage III lung cancer have brain metastasis, so a brain MRI is recommended as part of the initial staging for stage III lung cancer.
The addition of neoadjuvant chemotherapy to surgery improved the outcome compared with surgery alone.
Current standard of care for patients with unresectable stage III non-small cell lung cancer is a platinum-based doublet given concurrently with radiation, followed by immunotherapy with Durvalumab.
The median overall survival over two years has improved considerably with modern therapy.
A regimen of carboplatin and paclitaxel demonstrated similar efficacy with cis-platinum-etoposide with concurrent radiation treatment for stage III NSCLC.