Updated November 2013
About 30% of NSCLC patients have stage IV disease and a large proportion of patients with stage III NSCLC are not treatable with curative intent. Patients with a malignant pleural effusion are not curable and are most appropriately treated similarly to those with stage IV disease. (see management of pleural effusions section). Important prognostic factors include: stage, performance status and weight loss.
Treatment goals in these patients should always include palliation of symptoms and improvement in quality-of-life, but may include an attempt to prolong survival in patient groups suitable for chemotherapy. Treatment options include supportive care, palliative radiotherapy or chemotherapy. Toxicity of concurrent chemoradiation as applied in the curative setting is not justified in the palliative setting.
The prognosis for patients with stage IV NSCLC is poor with 6-10 month median survival times being typical even with the best available therapies. Most patients die within 1 or 2 years.