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Treatment options in stage III non-small cell lung cancer

Bianca Paraschiv 1,2 , Camelia Cristina Diaconu 2,3 , Stefan Dumitrache-Rujinski 1,2 , Ionela Nicoleta Belaconi 1,2 , Tudor Constantinescu 1,2 , Carmen Columbia Stroescu 1,2 , Elena Dantes 4,5 , Ariadna Petronela Fildan 4,5 , Miron Alexandru Bogdan 1,2 , Claudia Lucia Toma 1

Abstract: 

Lung cancer is responsible for over 1 million deaths annually, worldwide. The disease becomes symptomatic in advanced stages, so the diagnosis is delayed and 90% of cases cannot benefit from a curative treatment. In NSCLC surgical resection represents the best option for long term survival in resectable stage III and in clinical stage I/II. Patients with stage IIIB or IV usually receive chemotherapy or palliative treatment. For patients with no driver mutation detected platinum based combination chemotherapy is the first choice. Definitive radiotherapy is considered an lternative for patients who are not candidates for combined modality treatment. When a stage IV cancer is diagnosed based on an isolated metastasis, the patient’s benefit from the removal of the etastasis and of the primary tumor if it is resectable. The prognosis in NSLC is mainly influenced by the TNM stage at diagnosis. The rate of survival decreases in opposing correlation with the stage of the cancer. Poor performance status, reduced lung capacity, weight loss, vascular invasion are indicators for a poor prognosis.

Keywords: 
stage III, lung cancer, treatment

Lung cancer in today’s perspective
Lung cancer has become the leading cause of cancer related death all over the world, with over 1 million deaths annually (1) . The main risk factor for lung cancer remains tobacco smoking. The association between smoking and lung cancer was first described in 1950 (2) . Since then, the prevalence of smoking has increased and today cigarette smoking is responsible for 70% of age specific death rates in men and a less significant increase in women (3) . The incidence of lung cancer in individuals who have never smoked (defined as less than 100 smoked cigarettes in their lifetime) is estimated at 15% in men and 53% in women (4) . These findings suggest the involvement of other risk factors such as genetic features: epidermal growth factor receptor gene pathway (EGFR) alteration, the human repair gene (hMSH2) polymorphism, reduced activity of gluthatione-S-trasnferase enzymes. Other possible risk factors are viral infections, airflow obstruction, air pollution, and occupational carcinogens (arsenic, asbestos, beryllium, cadmium, ethers, nickel, silica) (5) . Regarding race and ethnicity, reports show a lower incidence of lung cancer among Hispanics (4) . Also, black people have a higher mortality rate than white patients. The incidence of lung cancer is higher in men than in women (4) .

References: 
  1. World Health Organization. Cancer. Fact sheet No 297. Reviewed January 2013. www.who.int/mediacentre/factsheets/fs297/en.(accessedMarch 2015)
  2. Doll R, Hill AB. Smoking and carcinoma of the lung; preliminary report. Br Med J. 1950; 2(4682): 739–748.
  3. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011; 61(2):69–90.
  4. William D. Travis, et al. The 2015 World Health Organization Classification of Lung Tumors. J Thorac Oncol. 2015;10: 1243–1260.
  5. Kauczor H-U, Bonomo L, Gaga M. Task force ESR/ERS white paper on lung cancer screening. Eur Respir J. 2015; 46: 28–39.

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