Stage III NSCLC: Staging, Treatment and Survival

Author: Paul Schipper, MD
Institution: OHSU
Date Reviewed: June 2025
Original Case: Stephen C. Yang, MD
Learning Domain: General Thoracic
Learning Objective: Stage III NSCLC: staging, treatment and survival
PowerPoint File: Stage III NSCLC: Staging, Treatment and Survival

 

Case Discussion Points for Conference

  • PET/CT shows high avidity in RUL nodule and in the right paratracheal node
  • What are the next diagnostic steps?
  • Further staging modalities?
  • Surgical approaches?
  • Preop vs postop therapy
  • Restaging modalities after induction therapy?

 

The term "induction" chemotherapy or radiation therapy or chemoradiation implies a first therapy given to down size or down stage a neoplasm such that a definitive therapy can be given.  It is more commonly used to describe head and neck therapies, and not lung cancer therapies.

Some physicians use induction and neoadjuvant as synonyms.

The term "neoadjuvant" applies to therapy given before surgery and can be chemotherapy, immunotherapy, radiation therapy or a combination.

Neoadjuvant therapy could be considered a subset of induction therapy.

 

Case Discussion Points for Conference Stage IIIA via N2 disease

Specific case scenarios/outcomes:

  • EBUS and mediastinoscopy are negative, but during lobectomy, frozen section of 4R positive for NSCLC
  • After induction therapy, see a complete radiologic response
  • After induction therapy, no change in PET avidity of RUL mass and adenopathy
  • After induction therapy, PET activity seen only in a left supraclavicular LN
  • After induction therapy, see progression of disease in the mediastinum

 

Case Discussion Points for Conference

  • PET/CT shows high avidity in RUL mass, no activity elsewhere
  • What are the next diagnostic steps?
  • Further staging modalities?
  • Treatment?

 

Learning Points

  • Staging modalities for advanced disease:  EBUS, EUS, MRI, mediastinoscopy, VATS
  • Indications for induction therapy
  • Extent of mediastinal adenopathy:  single node vs bulky adenopathy
  • N2:  induction therapy
  • N3:  definitive chemoradiation
  • Other definitions for stage IIIA and B disease