Treatment for Stage IIIB Non Small-Cell Lung Cancer (NSCLC)
Question
My mother has been diagnosed with stage IIIB non-small cell lung carcinoma with cancer also in the lymph nodes. There is a mass in her right upper lung and it is inoperable because of the stage it is in. They are treating her with radiation therapy and chemotherapy. I want to know what this treatment is going to do exactly – cure her, slow it down, or arrest it? Is this the best treatment she can get? What is her prognosis for this stage of cancer? What are the other treatment options? Does that mean it is beyond hope? Should we get a second opinion? Please help me. She is only 65 years old and is otherwise healthy.
Answer
Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds:
Stage IIIB non small-cell lung cancer (NSCLC) is defined as:
Cancer has invaded the aorta, great vessels of the heart, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, or other central mediastinal structures and also has spread to the lymph nodes in the center of the chest; or cancer has spread to the lymph nodes on the other side of the chest from where the cancer started or in the area around the clavicle (collarbone at the bottom of the neck).
Patients with stage IIIB non-small cell lung cancer are not considered to be candidates for definitive surgical resection, and patients are most often treated with chemotherapy and radiation therapy. In patients who are otherwise healthy, like your mother, chemotherapy and radiation therapy are delivered at the same time in an attempt to be as aggressive as possible and control the tumor locally in the chest and improve overall survival. In fact, a report from the West Japan Lung Cancer Group (WJLCG) randomized trial of 320 patients with stage III unresectable non-small cell lung cancer demonstrated a better response rate (84% vs. 66%), median survival time (16.5 months vs. 13.3 months), and more survivors at 5 years (15.8% vs. 8.9%) when chemotherapy and radiation therapy were delivered concurrently instead of one treatment followed by the other (Journal of Clinical Oncology 1999 Sep;17(9):2692-9).
The Radiation Therapy Oncology Group (RTOG) more recently also published their randomized study of 610 patients with locally advanced inoperable lung cancer treated with concurrent versus sequential chemotherapy and radiation therapy. Patients treated with both modalities concurrently also had a better response rate (70% vs. 61%), longer median survival time (17.0 months vs. 14.6 months), and more survivors at 5 years (16% vs. 10%) (J Natl Cancer Inst. 2011;103(19):1452-60.). So, it does sound like the treatment that your mother is receiving is appropriate for her stage of cancer. That being said, getting a second opinion is always an appropriate option, especially when facing such a challenging disease. Importantly, your mother's condition is not beyond hope. In some cases of Stage IIIB non-small cell lung cancer, there is a small but very real possibility of eradicating the cancer with radiation therapy, and there is definitively hope of cure!
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