The Possibility of Definitive Chemoradiotherapy for Patients with Resectable Stage IIIA N2 Non-Small Cell Lung Cancer

Abstract

The 2014 edition of the clinical guidelines for lung cancer in Japan included the following description, "Surgical resection may be considered after induction therapy for patients with clinical N2-IIIA non-small cell lung cancer (NSCLC)." However, the definition of resectable lung cancer may vary from institution to institution, and preoperative chemotherapy regimens and radiation doses have not been standardized. Moreover, large-scale clinical trials including INT0139, EORTC08941 could not prove the significance of surgery in combination with preoperative treatment for patients with stage III NSCLC. Recently, chemoradiotherapy has been associated with improved clinical outcomes in patients with unresectable stage III NSCLC. Some phase II trials have shown 2-year overall survival rates of 40-80%; thus, with appropriate patient selection, some patients with resectable stage III NSCLC may be completely cured with chemoradiotherapy. The West Japan Oncology Group, which has been developing a new treatment strategy for patients with unresectable stage III NSCLC, reported the first results of WJOG5008L at ASCO2015. We review the possible use of chemoradiotherapy in the treatment of patients with resectable stage III NSCLC with reference to the first results from WJOG5008L.