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Treatment of Stage IIIA Non-small Cell Lung CancerPotentially Resectable N2 Disease

6. Induction (Neoadjuvant) Therapy: Patients with stage IIIA (N2) lung cancer identified preoperatively have a relatively poor prognosis when treated with surgery as a single modality. Several small trials of induction chemotherapy have yielded conflicting results about its effect on survival. The relative roles of surgery and radiation therapy as the local treatment modality are also not clearly defined. Definitive treatment recommendations are difficult to make in this setting. Therefore, patients in this subset should be referred for multidisciplinary evaluation before embarking on definitive treatment. Level of evidence: poor; benefit: none; grade of recommendation: I
7. Induction (Neoadjuvant) Therapy: Whenever possible, induction (neoadjuvant) therapy followed by surgery for stage IIIA disease should be carried out in the setting of a clinical trial. Level of evidence: fair; benefit: moderate; grade of recommendation: B
8. Induction (Neoadjuvant) Therapy: Bimodality or trimodality therapy is better than surgery alone for locally advanced stage IIIA lung cancer. Level of evidence: good; benefit: substantial; grade of recommendation: A
9. Surgical Consideration: Incompletely resected patients have poor survival, and debulking procedures should be avoided. Level of evidence: fair; benefit: negative; grade of recommendation: D
10. Surgical Consideration: Incompletely resected patients and those with residual nodal disease found at surgery should be considered for postoperative radiotherapy. Level of evidence: poor; benefit: moderate; grade of recommendation: B.
C. Unresectable, Bulky N2 Disease canadian pharmacy mall

11. Combination Chemotherapy and Radiotherapy: In patients with good PS, radiotherapy should not be administered alone in treating unresectable stage IIIA lung cancer. Level of evidence: good; benefit: negative; grade of recommendation: D
12. Combination Chemotherapy and Radiotherapy: In patients 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
13. Combination Chemotherapy and Radiotherapy: Because in patients with stage IIIA lung cancer the optimal technique of combining chemotherapy and radiotherapy has not be determined, then factors such as patient performance status and age should be used to guide treatment planning. Level of evidence: poor; benefit: small; grade of recommendation: I