What is the best practice radiotherapy approach in patients with stage II inoperable NSCLC?

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What is the best practice radiotherapy approach in patients with stage II inoperable NSCLC?

As in stage I NSCLC, surgery is the standard of care for patients with stage II NSCLC. In patients who are not fit for surgery, radiotherapy may be a curative option.

Stage II disease constitutes a small proportion of all patients with NSCLC, therefore, it is unusual to find studies restricted to this population of patients. In the CHART study, 7% of patients had stage II disease;[1] in the CHARTWEL study, it was 6%.[2] A randomised phase 3 trial of conventional radiotherapy (55 Gy in 20 fractions) with and without concomitant gemcitabine in patients with stage I and II NSCLC was closed early because of slow accrual.[3] There were no differences in survival between arms but significantly more adverse events in patients randomised to gemcitabine. Because of the paucity of evidence for inoperable node positive stage II disease, it seems reasonable to use the recommendation guidelines for node positive stage III disease, to which the reader is directed, (refer radiotherapy stage III inoperable).

Evidence summary and recommendations

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Patients with inoperable stage II disease could be offered radiotherapy with curative intent with or without concomitant chemotherapy.
Last reviewed November 2015

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References

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Appendices

Further resources

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