Updated February 2008
Unresectable stage III NSCLC patients appropriate for combined modality therapy must have a good performance status (ECOG 0 to 1) and minimal weight loss (less than 5% in the preceding three months). Favourable distribution of thoracic disease for definitive local therapy (surgery or radical radiotherapy) is a major factor. It is crucial that all treating oncologists (thoracic surgeon, radiation oncologist and medical oncologist) mutually agree on the proposed treatment plan and the suitability of the individual patient for such therapy before any component of therapy has commenced. Such cases should be considered for a Multi-disciplinary Lung Conference.
Active patient participation in decision making respects the fundamental ethical and legal doctrine of autonomy, while exploring the concerns of these individuals, including functional limitations, symptom distress, and significant side effects of therapy. Patient preferences for therapy vary widely, with some patients choosing to avoid side effects and others willing to accept side effects for a chance of improved survival.