• Okawara G, Mackay JA, Evans WK, Ung YC, Lung Cancer Disease Site Group. Management of unresected stage III non-small cell lung cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Jan. 50 p. [117 references]

• For patients with good performance status (Eastern Cooperative Oncology Group, 0-1) and minimal weight loss (usually defined as <5% in the preceding three months):
  • Chemoradiation improves survival compared with radiotherapy alone and concurrent chemoradiation is recommended, with cisplatin-based chemotherapy and thoracic radiation of at least 60 gray (Gy) in 30 fractions given over a six-week period.
  • Insufficient evidence exists to recommend a specific cisplatin-based regimen for use in a concurrent chemoradiation schedule. However, in the opinion of the Lung Cancer Disease Site Group, reasonable treatment options include cisplatin combined with one of etoposide, vinorelbine, or vinblastine.
• For symptomatic patients with poor performance status (Eastern Cooperative Oncology Group, >1) and significant weight loss (usually defined as >10% in the preceding three months):
  • Radiotherapy for symptom palliation is recommended.
  • Insufficient evidence exists to determine the optimal dose or timing of radiotherapy when the goal of therapy is symptom palliation. Reasonable treatment options include 20 Gy in five fractions and 17 Gy in two fractions given one week apart. Radiotherapy administered in a single fraction of 10 Gy is not recommended based on the decreased survival and quality of life observed when compared with multifractionated radiotherapy in one Canadian trial. However, in the opinion of the Lung Cancer Disease Site Group, single fractions of radiotherapy less than 10 Gy may be appropriate in some clinical circumstances.
  • Palliative chemotherapy for patients with stage III disease is not reviewed in this guideline. For guidelines on palliative chemotherapy for locally advanced (stage IIIB) or metastatic (stage IV) disease, please visit the Cancer Care Ontario Web site.
• For patients with borderline performance status or moderate weight loss (5-10%):
  • Concurrent or sequential chemoradiation is an option though the quality and quantity of evidence is not as compelling as that for patients with good performance status and minimal weight loss.
• Hyperfractionated radiation is not recommended outside the context of a clinical trial (see Related Guidelines section in the original guideline document).

None provided

The recommendations are supported by randomized controlled trials and meta-analyses.

• Okawara G, Mackay JA, Evans WK, Ung YC, Lung Cancer Disease Site Group. Management of unresected stage III non-small cell lung cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Jan. 50 p. [117 references]

Not applicable: The guideline was not adapted from another source.

1997 Mar 14 (revised 2006 Jan)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Lung Cancer Disease Site Group

The primary authors of this guideline report declared no potential conflicts of interest.

This summary was completed by ECRI on January 5, 1999. The information was verified by the guideline developer as of February 22, 1999. This NGC summary was updated by ECRI on December 17, 2001 and most recently on July 21, 2003. The most recent information was verified by the guideline developer as of August 6, 2003. This NGC summary was updated by ECRI Institute on June 5, 2007. The updated information was verified by the guideline developer on June 13, 2007.