Treatment for Stage 3 Lung Cancer: Surgery, Radiation, Chemotherapy, and Immunotherapy

The treatment for stage 3 lung cancer depends on if you have stage 3A or a more advanced stage 3 cancer like stage 3B or stage 3C. The decision to proceed with surgery for stage 3A lung cancer is not always black and white, and it’s an area where doctors can disagree. In stage 3A, where the cancer has spread to the lymph nodes on the same side of the chest where the cancer started, surgery can play a role depending on where the cancer is, how close it is to other structures, and how many lymph nodes are affected. Chemotherapy or radiation may also be an option before surgery to shrink the tumor and destroy any errant cancer cells. In other scenarios, some people with stage 3A cancer will be treated with radiation therapy and chemotherapy followed by immunotherapy without surgery. If the cancer is EGFR+ targeted therapies may be added post-surgery as well. Immunotherapy drug pembrolizumab (Keytruda) may be used alone as your first treatment when your lung cancer has not spread outside your chest (stage III) and you cannot have surgery or chemotherapy with radiation.

With stage 3B lung cancer, or stage 3C your cancer has spread to the lymph nodes on the opposite side of your chest or has invaded another area such as the veins feeding your heart. For patients with stage 3B and 3C lung cancer, radiation therapy with chemotherapy followed by immunotherapy is the standard of care.