4
Diagnosis
Recommendation 1.6
➤ For patients who have suspected or confirmed stage III NSCLC,
multidisciplinary discussion should occur prior to the initiation of any
treatment plan. (Strong recommendation; EB-B-M)
Good Practice Point
➤ Biopsy should generally be performed from the site that would
establish the highest stage when feasible. Potential tissue yield
for pathologic analysis and molecular sequencing should also be
considered.
Surgery
Recommendation 2.1
➤ For patients with stage IIIA (N2) NSCLC, induction therapy followed by
surgery (with or without adjuvant therapy) may be offered if all of the
following conditions are met:
a. A complete resection (R0) of the primary tumor and involved lymph nodes is
deemed possible.
b. N3 lymph nodes are deemed to be not involved by multidisciplinary consensus.
c. Perioperative (90-day) mortality is expected to be low (≤5%).
(Weak recommendation; EB-B-M)
Recommendation 2.2
➤ For selected patients with T4N0 disease (by size or extension),
surgical resection may be offered if medically and surgically feasible
following multidisciplinary review. (Weak recommendation; EB-B-M)
Good Practice Points
➤ Patients with stage III NSCLC generally should not be excluded from
consideration for surgery by nonsurgical physicians.
➤ Presence of oncogenic driver alterations, available therapies, and
patient characteristics should be taken into account.
➤ Patients and providers should consider enrollment on clinical trials
when appropriate.
