RT Book, Section A1 Spicer, Jonathan D. A1 Hofstetter, Wayne L. A2 Morita, Shane Y. A2 Balch, Charles M. A2 Klimberg, V. Suzanne A2 Pawlik, Timothy M. A2 Posner, Mitchell C. A2 Tanabe, Kenneth K. SR Print(0) ID 1145759393 T1 Lung Cancer: Stage III and IV T2 Textbook of Complex General Surgical Oncology YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9780071793315 LK accesssurgery.mhmedical.com/content.aspx?aid=1145759393 RD 2024/03/28 AB The treatment of lung cancer is in constant evolution. As the leading cause of cancer-related deaths worldwide, this highly lethal malignancy presents numerous therapeutic challenges. This chapter focuses on patients with stage III and IV lung cancer or in other words, locally advanced and metastatic lung cancer. About 80% of patients with lung cancer develop non-small cell lung carcinoma (NSCLC) type histology and these are the patients upon which this chapter will focus. The remaining 20% develop small cell carcinoma, which when locally advanced, given current therapeutics, is a uniformly nonsurgical disease treated primarily with chemotherapy. Despite increasing resolution in diagnostic imaging and attempts to screen high-risk patients, 65% of NSCLC patients continue to present with advanced disease (stage III or higher).1 Nevertheless, this is a heterogeneous group of patients who require a spectrum of management strategies ranging from curative intent therapy to palliative care. The common thread within this spectrum is the added value of customized care that implements a multimodality approach. Advances in our understanding of lung cancer biology have led to the incorporation of targeted therapies that likely hold the greatest promise for improving outcomes in this patient population.2 Refinements in stereotactic radiotherapy protocols, aggressive multiagent chemotherapy regimens, advances in surgical technique and recovery have all contributed to improved survival from advanced lung cancer. However, in many clinical scenarios the ideal combination of these modalities and their timing remains to be determined. This chapter summarizes the state of the art in the care of advanced NSCLC with the understanding that several areas remain controversial and that the coming years will bring significant changes leading to improved outcomes for this vulnerable population.