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Treatment of Stage IIIA Non-small Cell Lung Cancer: unresectable IIIA (N2) disease

Newer-generation chemotherapeutic agents, alone or in combination with the platinum agents, are being incorporated into combined modality chemotherapy plus radiotherapy for locally advanced disease. As an example, a recent phase II trial in locally advanced disease used induction paclitaxel with carboplatin followed by weekly doses concurrent with radiotherapy. This treatment yielded a good response rate (55%) in 38 evaluable patients, with a 1-year survival of 72% and a tolerable toxicity profile.
Other phase I and II trials have reported the feasibility of combining docetaxel, gemcitabine, and irino-tecan in concurrent design with radiotherapy but also do report a range of toxicity profiles. Phase III trials are needed that incorporate these newer, active agents in various dosing schedules with radiotherapy in standard and altered fractionation schedules to define the optimal role of these agents in treatment strategies for unresectable IIIA (N2) disease.
Recommendations
In patients with good PS, radiotherapy should not be used alone in treating unresectable stage IIIA lung cancer. Level of evidence: good; benefit: negative; grade of recommendation: D canadian drug mall

In the patient with unresectable locally advanced lung cancer, platinum-based chemotherapy plus radiotherapy provides improved survival rates over radiotherapy alone and should be used for primary treatment. Level of evidence: good; benefit: substantial; grade of recommendation: A
Because in patients with stage IIIA lung cancer the optimal technique of combining chemotherapy and radiotherapy has not be determined, factors such as patient PS and age should be used to guide treatment planning. Level of evidence: poor; benefit: small; grade of recommendation: I