☆ 4.6 Review

Current and Future Treatment Options in the Management of Stage III NSCLC

JOURNAL OF THORACIC ONCOLOGY (2023)

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Article Oncology

Treatment Characteristics and Real-World Progression-Free Survival in Patients With Unresectable Stage III NSCLC Who Received Durvalumab After Chemoradiotherapy: Findings From the PACIFIC-R Study

Nicolas Girard et al.

Summary: This study analyzed the treatment characteristics and real-world progression-free survival (rwPFS) of patients receiving durvalumab, and the results showed that in patients with advanced lung cancer, rwPFS was longer in patients who received concurrent chemoradiotherapy and in patients with higher programmed cell death-ligand 1 expression.

JOURNAL OF THORACIC ONCOLOGY (2023)

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Article Oncology

Brief Report: Durvalumab After Chemoradiotherapy in Unresectable Stage III EGFR-Mutant NSCLC: A Post Hoc Subgroup Analysis From PACIFIC

Jarushka Naidoo et al.

Summary: This study examined the efficacy of immunotherapy in patients with EGFR-mutant NSCLC. The results showed that durvalumab had similar PFS and OS compared to placebo, but due to small sample size and lack of prospective studies, further research is needed to determine the optimal treatment for EGFR-mutant NSCLC.

JOURNAL OF THORACIC ONCOLOGY (2023)

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Article Oncology

Original Article Cardiac Morbidity Following Chemoradiation in Stage III Non-small Cell Lung Cancer Patients: A Population-Based Cohort Study

E. K. Donovan et al.

Summary: This study aimed to evaluate the risk of cardiac toxicity in advanced lung cancer patients after radical radiotherapy. Patients with stage III non-small cell lung cancer (NSCLC) receiving chemoradiotherapy were included from a population-based cohort in Ontario, Canada. The primary outcome was cardiac toxicity, assessed as cardiac events or congestive heart failure, at 1 and 5 years post-chemoradiotherapy. Secondary outcomes included overall survival, survival in relation to post-treatment cardiac events, and the impact of radiotherapy technique on cardiac toxicity. The results showed that the cumulative incidence of cardiac toxicity at 5 years was 20.3% (18.4-22.3) in the NSCLC patients. Median survival was shorter in NSCLC patients who experienced a cardiac event post-chemoradiotherapy compared to those who did not. There was a trend towards increased cumulative cardiac toxicity with three-dimensional conformal radiotherapy compared to other techniques. In conclusion, there is a high risk of cardiac events and congestive heart failure 5 years after radical thoracic radiotherapy, and survival is inferior in patients who experience a cardiac event post-treatment. More conformal radiotherapy techniques may help reduce cardiac toxicity. Further studies should explore adaptive treatment planning and close monitoring and intervention in this high-risk group after chemoradiotherapy.

CLINICAL ONCOLOGY (2023)

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Review Oncology

Real-World Safety and Efficacy of Consolidation Durvalumab After Chemoradiation Therapy for Stage III Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis

Yu Wang et al.

Summary: This meta-analysis examined the real-world toxicity and efficacy of consolidation durvalumab after chemoradiation therapy in stage III NSCLC patients. It found differences in patient characteristics between real-world studies and clinical trials, but overall safety and short-term efficacy aligned with the results of clinical trials.

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2022)

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Article Oncology

Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer

David R. Spigel et al.

Summary: The study examined the efficacy of consolidation durvalumab in patients with non-small-cell lung cancer, showing significant improvements in overall survival and progression-free survival, with manageable safety. The 5-year follow-up data continued to demonstrate the positive effects of durvalumab on survival and disease progression.

JOURNAL OF CLINICAL ONCOLOGY (2022)

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Article Oncology

Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial

Cecile Le Pechoux et al.

Summary: This study aimed to investigate whether three-dimensional conformal radiotherapy (3D PORT) should be part of the standard treatment for patients with non-small-cell lung cancer (NSCLC) with N2 involvement. The results showed that 3-year disease-free survival was slightly higher in patients with PORT compared to those without, but the difference was not significant.

LANCET ONCOLOGY (2022)

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Article Oncology

Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim results of a randomised, double-blind, multicentre, phase 3 trial

Qing Zhou et al.

Summary: The efficacy and safety of sugemalimab, an anti-PD-L1 antibody, were assessed in patients with unresectable stage III non-small-cell lung cancer (NSCLC) who had not progressed after concurrent or sequential chemoradiotherapy. The results showed that sugemalimab significantly prolonged progression-free survival in these patients.

LANCET ONCOLOGY (2022)

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Article Oncology

Residual ctDNA after treatment predicts early relapse in patients with early-stage non-small cell lung cancer

D. Gale et al.

Summary: Detection of ctDNA using sensitive patient-specific assays after initial treatment has the potential to identify early-stage NSCLC patients who may benefit from further therapeutic intervention.

ANNALS OF ONCOLOGY (2022)

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Editorial Material Oncology

VP3-2022: Pembrolizumab (pembro) versus placebo for early-stage non-small cell lung cancer (NSCLC) following complete resection and adjuvant chemotherapy (chemo) when indicated: Randomized, triple-blind, phase III EORTC-1416-LCG/ETOP 8-15 e PEARLS/KEYNOTE-091 study

L. Paz-Ares et al.

Summary: This study evaluated the efficacy of adjuvant pembrolizumab compared to placebo in patients with completely resected early-stage non-small cell lung cancer. The results showed that adjuvant pembrolizumab significantly improved disease-free survival in the overall population, but did not reach statistical significance in the PD-L1 expression >= 50% population. Adverse events were more common in the pembrolizumab group compared to the placebo group.

ANNALS OF ONCOLOGY (2022)

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Review Oncology

Radiomics for Predicting Lung Cancer Outcomes Following Radiotherapy: A Systematic Review

G. M. Walls et al.

Summary: The radiomic phenotype of lung cancer has the potential to guide clinical decision-making in radical radiotherapy. However, there is currently a lack of validated biomarkers for personalized radical radiotherapy in lung cancer. Analysis of radiomics studies reveals that certain imaging features are strongly associated with clinical outcomes. Nonetheless, challenges remain in the field of radiomics, including data standardization, quality reporting, and external validation of radiomic signatures.

CLINICAL ONCOLOGY (2022)

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Article Oncology

COAST: An Open-Label, Phase II, Multidrug Platform Study of Durvalumab Alone or in Combination With Oleclumab or Monalizumab in Patients With Unresectable, Stage III Non-Small-Cell Lung Cancer

Roy S. Herbst et al.

Summary: The COAST study evaluated the efficacy of durvalumab combined with other antibodies in patients with unresectable stage III non-small-cell lung cancer. The results showed that compared to durvalumab alone, the combination of durvalumab with oleclumab or monalizumab significantly improved the objective response rate and progression-free survival of patients.

JOURNAL OF CLINICAL ONCOLOGY (2022)

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Article Oncology

Multitask Learning Radiomics on Longitudinal Imaging to Predict Survival Outcomes following Risk-Adaptive Chemoradiation for Non-Small Cell Lung Cancer

Parisa Forouzannezhad et al.

Summary: In this study, the utility of a multitask machine learning radiomics framework for survival outcome prediction in patients with non-small cell lung cancer (NSCLC) was evaluated. The study found that multitask learning of FDG-PET radiomics achieved higher survival prediction than other modalities and clinical benchmarks. The results highlight the potential importance of multitask learning radiomics in personalized cancer treatment strategies.

CANCERS (2022)

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Article Oncology

Durvalumab After Sequential Chemoradiotherapy in Stage III, Unresectable NSCLC: The Phase 2 PACIFIC-6 Trial

Marina C. Garassino et al.

Summary: The study included 117 patients with advanced unresectable stage III NSCLC, showing that durvalumab after sequential CRT has a comparable safety profile to durvalumab after concurrent CRT and has promising preliminary efficacy in a frailer population.

JOURNAL OF THORACIC ONCOLOGY (2022)

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Article Oncology

PL03.12 Progression Free Survival and Overall Survival in NADIM II Study

M. Provencio et al.

Journal of Thoracic Oncology (2022)

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Article Oncology

Final efficacy outcomes of atezolizumab with chemoradiation for unresectable NSCLC: The phase II DETERRED trial

Yufei Liu et al.

Summary: The DETERRED trial evaluated the safety and efficacy of consolidation and concurrent immunotherapy with chemoradiation in unresectable locally advanced non-small cell lung cancer. The results demonstrated comparable efficacy to consolidative durvalumab in the PACIFIC trial. Targetable driver oncogene mutations were associated with worse progression-free survival, while PD-L1 <1% trended towards worse progression-free survival.

LUNG CANCER (2022)

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Article Oncology

Complete pathologic response to short-course neoadjuvant alectinib in mediastinal node positive (N2) ALK rearranged lung cancer

Daniel Sentana-Lledo et al.

Summary: This study reported two cases of lung cancer patients who showed significant pathologic responses after receiving neoadjuvant alectinib therapy. The results highlight the potential of second-generation ALK inhibitors to induce major and complete pathologic responses in the neoadjuvant setting.

LUNG CANCER (2022)

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Article Biochemistry & Molecular Biology

Neoadjuvant atezolizumab for resectable non-small cell lung cancer: an open-label, single-arm phase II trial

Jamie E. Chaft et al.

Summary: This study examined the use of neoadjuvant atezolizumab in patients with resectable non-small cell lung cancer. It found that profiles of innate immune cells in pre-treatment peripheral blood may predict pathological response after neoadjuvant atezolizumab, but further studies are needed to confirm these findings.

NATURE MEDICINE (2022)

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Article Oncology

A phase II, multicenter study of lazertinib as consolidation therapy in patients with locally advanced, unresectable, EGFR mutation-positive non-small cell lung cancer (stage III) who have not progressed following definitive, platinum-based, chemoradiation therapy (PLATINUM trial)

Juwhan Choi et al.

Summary: This study aims to evaluate the efficacy and safety of lazertinib as a consolidative therapy for EGFR mutation-positive stage III NSCLC patients after CCRT treatment. The results may expand the indications for third-generation EGFR-TKIs in treating stage III NSCLC and emphasize the value of mutation analysis and personalized medicine.

THORACIC CANCER (2022)

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Meeting Abstract Oncology

IMpower010: Biomarkers of disease-free survival (DFS) in a phase III study of atezolizumab (atezo) vs best supportive care (BSC) after adjuvant chemotherapy in stage IB-IIIA NSCLC

C. Zhou et al.

ANNALS OF ONCOLOGY (2021)

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Article Oncology

Osimertinib Maintenance After Definitive Chemoradiation in Patients With Unresectable EGFR Mutation Positive Stage III Non-small-cell Lung Cancer: LAURA Trial in Progress

Shun Lu et al.

Summary: The LAURA trial aims to evaluate the efficacy and safety of osimertinib as maintenance therapy in patients with locally advanced, EGFR mutation-positive stage III NSCLC. Patients meeting specific criteria will be randomized into either the osimertinib or placebo group, with the primary objective being to assess osimertinib's progression-free survival (PFS) confirmed by independent review.

CLINICAL LUNG CANCER (2021)

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Article Oncology

Association of Left Anterior Descending Coronary Artery Radiation Dose With Major Adverse Cardiac Events and Mortality in Patients With Non-Small Cell Lung Cancer

Katelyn M. Atkins et al.

Summary: This cohort study explores the impact of radiation doses to cardiac substructures on major adverse cardiac events and mortality in patients with locally advanced non-small cell lung cancer. The findings suggest that dose exposure to the left anterior descending coronary artery may be an independent factor associated with adverse cardiac events and mortality, with significant interaction with baseline coronary heart disease status. Further validation and optimization of risk mitigation strategies are needed.

JAMA ONCOLOGY (2021)

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Review Oncology

Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival

Ana Casal-Mourino et al.

Summary: Stage III non-small cell lung cancer (NSCLC) presents a highly heterogeneous group of patients with diverse treatment approaches including chemotherapy, radiation, and surgery. Due to the heterogeneity of patient populations and limitations of study methods, there are controversies surrounding the treatment of stage III disease. Additionally, changes in disease definition and early research studies impact the interpretation of treatment outcomes and patient classification for stage III NSCLC.

TRANSLATIONAL LUNG CANCER RESEARCH (2021)

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Article Oncology

Progression-Free and Overall Survival for Concurrent Nivolumab With Standard Concurrent Chemoradiotherapy in Locally Advanced Stage IIIA-B NSCLC: Results From the European Thoracic Oncology Platform NICOLAS Phase II Trial (European Thoracic Oncology Platform 6-14)

Solange Peters et al.

Summary: The NICOLAS study evaluated the safety and efficacy of adding nivolumab to standard definitive concurrent chemoradiotherapy in stage III NSCLC patients. The 1-year progression-free survival rate was 53.7% and the median overall survival was 38.8 months. Patients with stage IIIA disease had a significantly higher survival rate compared to those with stage IIIB disease.

JOURNAL OF THORACIC ONCOLOGY (2021)

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Review Oncology

Cardiac Toxicity of Thoracic Radiotherapy: Existing Evidence and Future Directions

Kathryn Banfill et al.

Summary: The impact of radiotherapy on the heart is a growing area of interest, with no consistent cardiac dose-volume constraints identified. While many lung cancer patients undergoing treatment have cardiovascular risk factors, there is limited evidence on the effects of radiotherapy on the heart in these patients.

JOURNAL OF THORACIC ONCOLOGY (2021)

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Article Oncology

Durvalumab for Stage III EGFR-Mutated NSCLC After Definitive Chemoradiotherapy

Jacqueline V. Aredo et al.

Summary: Consolidation durvalumab did not benefit patients with EGFR-mutated unresectable stage III NSCLC and was associated with a high frequency of immune related adverse events. Patients who switched to osimertinib after durvalumab treatment may be more susceptible to incident adverse events. Further investigation is needed for concurrent CRT with induction or consolidation EGFR TKIs as definitive treatment.

JOURNAL OF THORACIC ONCOLOGY (2021)

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Article Biochemistry & Molecular Biology

Neoadjuvant nivolumab or nivolumab plus ipilimumab in operable non-small cell lung cancer: the phase 2 randomized NEOSTAR trial

Tina Cascone et al.

Summary: The NEOSTAR trial showed that neoadjuvant treatment with nivolumab + ipilimumab combination therapy can improve pathologic response rates in operable NSCLC patients and has better clinical efficacy compared to nivolumab alone.

NATURE MEDICINE (2021)

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Article Oncology

95TiP DUART: A phase II study of durvalumab following radiotherapy in patients with unresectable, stage III NSCLC ineligible for chemotherapy

A.R. Filippi et al.

Journal of Thoracic Oncology (2021)

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Article Oncology

Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial

Nasser K. Altorki et al.

Summary: The combination of neoadjuvant durvalumab and stereotactic body radiotherapy in early-stage NSCLC patients shows a high major pathological response rate and is well tolerated, suggesting its potential in treatment, although it comes with certain adverse events.

LANCET ONCOLOGY (2021)

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Review Radiology, Nuclear Medicine & Medical Imaging

Current status and quality of radiomic studies for predicting immunotherapy response and outcome in patients with non-small cell lung cancer: a systematic review and meta-analysis

Qiuying Chen et al.

Summary: Radiomics has the potential to predict immunotherapy response and outcomes in patients with NSCLC noninvasively. The mean radiomics quality score for included studies was 29.6%, with a wide variation in scores. Radiomics can divide patients into different risk groups with significant differences in overall survival and progression-free survival, showing promise as a predictive tool.

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING (2021)

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Article Medicine, General & Internal

Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial

Enriqueta Felip et al.

Summary: IMpower010 study demonstrated a disease-free survival benefit with adjuvant atezolizumab versus best supportive care in patients who underwent complete resection followed by adjuvant chemotherapy, especially in the subgroup whose tumors expressed PD-L1 on 1% or more of tumor cells.

LANCET (2021)

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Article Oncology

Effect of Postoperative Radiotherapy for Patients With pIIIA-N2 Non-Small Cell Lung Cancer After Complete Resection and Adjuvant Chemotherapy The Phase 3 PORT-C Randomized Clinical Trial

Zhouguang Hui et al.

Summary: The study evaluated the impact of postoperative radiotherapy (PORT) on survival and safety in patients with pIIIA-N2 non-small cell lung cancer. The results showed that PORT did not improve disease-free survival but helped reduce local recurrence.

JAMA ONCOLOGY (2021)

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Article Oncology

Accelerated Hypofractionated Image-Guided vs Conventional Radiotherapy for Patients With Stage II/III Non-Small Cell Lung Cancer and Poor Performance Status A Randomized Clinical Trial

Puneeth Iyengar et al.

Summary: This study found that hypofractionated IGRT was not superior to CFRT for patients with stage II/III NSCLC ineligible for concurrent chemoradiotherapy. Further studies are needed to verify equivalence between these radiotherapy regimens.

JAMA ONCOLOGY (2021)

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Article Oncology

Long-Term Results of NRG Oncology RTOG 0617: Standard- Versus High-Dose Chemoradiotherapy With or Without Cetuximab for Unresectable Stage III Non-Small-Cell Lung Cancer

Jeffrey D. Bradley et al.

JOURNAL OF CLINICAL ONCOLOGY (2020)

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Article Oncology

Imaging-based target volume reduction in chemoradiotherapy for locally advanced non-small-cell lung cancer (PET-Plan): a multicentre, open-label, randomised, controlled trial

Ursula Nestle et al.

LANCET ONCOLOGY (2020)

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Article Oncology

Outcomes with durvalumab by tumour PD-L1 expression in unresectable, stage III non-small-cell lung cancer in the PACIFIC trial

L. Paz-Ares et al.

ANNALS OF ONCOLOGY (2020)

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Meeting Abstract Oncology

Neoadjuvant atezolizumab (A) for resectable non-small cell lung cancer (NSCLC): Results from the phase II PRINCEPS trial

B. Besse et al.

ANNALS OF ONCOLOGY (2020)

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Article Medicine, General & Internal

Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer

Yi-Long Wu et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Article Oncology

Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib

A. J. Schoenfeld et al.

ANNALS OF ONCOLOGY (2019)

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Article Oncology

Osimertinib Plus Durvalumab versus Osimertinib Monotherapy in EGFR T790M-Positive NSCLC following Previous EGFR TKI Therapy: CAURAL Brief Report

James Chih-Hsin Yang et al.

JOURNAL OF THORACIC ONCOLOGY (2019)

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Article Cardiac & Cardiovascular Systems

Cardiac Radiation Dose, Cardiac Disease, and Mortality in Patients With Lung Cancer

Katelyn M. Atkins et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2019)

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Review Oncology

Current Status and Future Perspectives on Neoadjuvant Therapy in Lung Cancer

Gideon M. Blumenthal et al.

JOURNAL OF THORACIC ONCOLOGY (2018)

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Review Radiology, Nuclear Medicine & Medical Imaging

The 8th lung cancer TNM classification and clinical staging system: review of the changes and clinical implications

Wanyin Lim et al.

QUANTITATIVE IMAGING IN MEDICINE AND SURGERY (2018)

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Article Oncology

Early Detection of Molecular Residual Disease in Localized Lung Cancer by Circulating Tumor DNA Profiling

Aadel A. Chaudhuri et al.

CANCER DISCOVERY (2017)

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Article Oncology

PROCLAIM: Randomized Phase III Trial of Pemetrexed-Cisplatin or Etoposide-Cisplatin Plus Thoracic Radiation Therapy Followed by Consolidation Chemotherapy in Locally Advanced Nonsquamous Non-Small-Cell Lung Cancer

Suresh Senan et al.

JOURNAL OF CLINICAL ONCOLOGY (2016)

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Review Oncology

Chemoradiotherapy versus radiotherapy alone in elderly patients with stage III non-small cell lung cancer: A systematic review and meta-analysis

David E. Dawe et al.

LUNG CANCER (2016)

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Article Oncology

2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer

W. E. E. Eberhardt et al.

ANNALS OF ONCOLOGY (2015)

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Article Oncology

Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA(N2) and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy (ESPATUE)

Wilfried Ernst Erich Eberhardt et al.

JOURNAL OF CLINICAL ONCOLOGY (2015)

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Article Oncology

Multinational Randomized Phase III Trial With or Without Consolidation Chemotherapy Using Docetaxel and Cisplatin After Concurrent Chemoradiation in Inoperable Stage III Non-Small-Cell Lung Cancer: KCSG-LU05-04

Jin Seok Ahn et al.

JOURNAL OF CLINICAL ONCOLOGY (2015)

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Article Oncology

Sequential vs Concurrent Chemoradiation for Stage III Non-Small Cell Lung Cancer: Randomized Phase III Trial RTOG 9410

Walter J. Curran et al.

JOURNAL OF THE NATIONAL CANCER INSTITUTE (2011)

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Article Medicine, General & Internal

Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial

Kathy S. Albain et al.

LANCET (2009)

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Article Oncology

Impact of postoperative radiation therapy on survival in patients with complete resection and Stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: The Adjuvant Navelbine International Trialist Association (ANITA) randomized trial

Jean-Yves Douillard et al.

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2008)

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Article Oncology

Lung Adjuvant Cisplatin Evaluation: A pooled analysis by the LACE collaborative group

Jean-Pierre Pignon et al.

JOURNAL OF CLINICAL ONCOLOGY (2008)

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Article Oncology

Phase III trial of maintenance gefitinib or placebo after concurrent chemoradiotherapy and docetaxel consolidation in inoperable stage III non-small-cell lung cancer: SWOG S0023

Karen Kelly et al.

JOURNAL OF CLINICAL ONCOLOGY (2008)

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Review Oncology

Multimodality therapy for stage III non-small-cell lung cancer

D Farray et al.

JOURNAL OF CLINICAL ONCOLOGY (2005)

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