Clinical studies in Non-Small Cell Lung Cancer stage III

Primary lung cancer was first recognized as a distinct disease in 1761, long before the advent of cigarette smoking.1 Although it was a rare disease at the start of the 20th century,2,3,4,5 at the end, lung cancer had become one of the leading causes of preventable death. Since the 1930s, lung cancer rates rapidly increased following the introduction of the manufactured cigarettes. Exposure to inhaled carcinogens with addictive properties combined with a increasing life span makes lung cancer one of the biggest medical challences of the 20th century. In 2010, 11.435 people were diagnosed with lung cancer in The Netherlands, 6.992 of these patients were male and 4.443 were female.During the first decade of the 21 century, the number of women who developed lung cancer increased from 2.479 to 4.443 (79%).This ‘epidemic’ is the result of the growing number of females, who started smoking since the 70s. On Prognosis and Clinical evaluation of lung cancer: Approximately 85% of patients with lung cancer are diagnosed with non-small cell lung cancer (NSCLC).10 The overall survival of NSCLC remains poor and has not changed much over the past three decades. In the Western world, the 5 years overall survival is nowadays around the 13%. This is caused by the fact that the vast majority of lung cancer patients are diagnosed in the advanced stages. Only 20% of the patients with NSCLC are candidates for surgery at presentation. About one third of the patients with NSCLC have stage III disease at presentation. Prognosis in NSCLC stage III is poor, with a relative survival of 12% in NSCLC stage IIIB and 20% in NSCLC stage IIIA after three years.1Most important prognostic factors are disease stage and performance status. Stage III is a heterogeneous group of patients, ranging from patients with potentially resectable disease with chest wall invasion and hilar lymph node metastases (T3N1) and patients with mediastinal invasion of the primary tumour (T4), to patients with unresectable disease due to mediastinal lymph node metastases (N2/N3). Defining patients with NSCLC stage III, depends on the spread to regional or distant lymph nodes or other metastatic sites. Patients are staged according to the international TNM staging system. Before 2009, patients were staged according the 6th TNM-staging system, and after 2009 they were staged according the revised 7th TNM staging system. The main goal of this thesis is to evaluate (minimal invasive) diagnostic techniques and the resultsof multimodality treatment in NSCLC stage III. Treatment of patients with supraclavicular lymph node metastases, invasion of the superior sulcus, brachial plexus or malignant pleural effusion will not be discussed. This thesis is divided into four sections. In the first section (chapter 2-5), the value of (minimal) invasive staging and restaging techniques in NSCLC stage III will be addressed. The second (chapter 6-8) includes clinical studies concerning the role of surgery in the treatment of NSCLC stage IIIA/B and its complications. Part three describes the complications of combined modality treatment . Section four includes the summary in English and Dutch