Cons: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with inoperable large volume stage III non-small cell lung cancer

The treatment of stage III unresectable non-small cell lung cancer (NSCLC) remains a significant challenge despite approximately 40 years of clinical trial activity in this patient population (1,2). Medical imaging, nuclear medicine, image-guided radiation treatment, radiation treatment delivery, and systemic treatments all have significantly improved the medical care of these patients (3). Historically, part of the challenge in the management of stage III NSCLC has been its heterogeneity in terms of tumor location, primary (T4—multifocal or invasive disease versus lower T stage) and nodal (N3 vs. lower N stage) extent of spread, cancer histology as well as various patient factors such as patient age, weight loss, performance status, and comorbidities. More recently, the diversity of NSCLC in terms of potential EGFR and ALK genetic alterations have further defined (and complicated) the ideal treatment of this disease entity.