Treatment of Stage IIIB Non-Small Cell Lung Cancer

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

A stage IIIB non-small cell lung cancer (NSCLC) has already spread to the lymph nodes on the opposite side of the chest, but no secondary cancer can be detected outside the chest cavity. Unfortunately, most patients with this stage of cancer do have undetectable cancer outside the chest.

This undetectable cancer is the cause of relapse or cancer recurrence in most patients. Another sign of stage IIIB disease is the presence of fluid in the chest. An effective therapy is needed to help improve cure rates. Research on this is currently in progress.

When deciding whether to get treatment for NSCLC, you should be aware of the goals of your therapy. Treatment may be given to improve symptoms, to increase the chance of a cure, or to prolong life. You and your doctor should carefully balance the potential benefits of receiving cancer treatment with the potential risks.

The following is a general overview of the treatment of stage IIIB NSCLC. Your individual situation may influence your decision to have treatment and what type it should be. The potential benefits of receiving treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate you about your treatment options. It can help you when you make decisions with the cancer specialist who treats you.

Most new treatments are developed in clinical trials. These are studies that evaluate the safety and effectiveness of new drugs or treatments. Clinical trials make it possible to develop more effective cancer treatments. If you take part in a clinical trial, you may get better treatments. You will also help to advance knowledge about treatment of NSCLC.

Clinical trials are available for most stages of cancer. If you are interested in participating in a clinical trial, you should discuss with your physician the risks and benefits of taking part. In any case, you should stay informed by following the news about cancer trials. In this way, you can make sure that you are receiving the best treatment available.

Optimal treatment of patients with stage IIIB lung cancer often requires more than one therapeutic approach. Thus, it may be necessary for you to be treated at a medical center that can offer multimethod treatment involving medical oncologists, radiation oncologists, surgeons, and specialists in pulmonary (lung-related) medicine.

Combined Method Treatment

When NSCLC has spread to more than one area in the chest, it cannot be effectively removed with surgery. Most patients with stage IIIB cancers used to be treated with either radiation or chemotherapy. Less than 10 percent survived for 5 years.

Doctors have now learned that combining chemotherapy with radiation therapy may improve a patient's chance for survival. Patients treated with chemotherapy and radiation therapy together are almost twice as likely to be living 5 years after treatment compared to patients treated with radiation alone.

More recently, clinical studies suggest that the use of chemotherapy and radiation therapy at the same time also improves survival time compared with radiation alone. As a result of such trials, combined therapy using both chemotherapy and radiation has become standard treatment for patients with stage IIIB cancers.

Chemotherapy as Primary Treatment

If you have stage IIIB NSCLC and are unable or unwilling to receive radiation therapy, you can be treated with chemotherapy alone to alleviate the symptoms of your disease and prolong survival time. Chemotherapy for stage IIIB NSCLC usually consists of two drugs: platinum or nonplatinum containing regimens.

Treatment of Elderly Patients

Older patients (those over 70) with NSCLC can be treated just as well as younger patients depending on how significantly the disease has affected their everyday lives. In fact, studies suggest that chemotherapy for advanced NSCLC is as effective in elderly patients as in younger patients, so there is no reason to deny therapy based solely on age. Yet only about 20 percent of elderly patients with advanced NSCLC ever receive chemotherapy.

The type of chemotherapy used depends on patients overall condition and how far the disease has progressed. If their cancer is significantly affecting their everyday life, particularly if their other health conditions, they may only be treated with one medication rather than two or more.  

Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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