PET scan showing cancer in the right upper lobe invading into the mediastinum (stage stage III)
The cure rates with early stage lung cancer may be quite good (go here) for the more common advanced lung cancer (stage IIIA) the results are still reasonable, when radiation is combined with chemotherapy, see studies here and below
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Another recent study of advanced (stage IIIA) lung cancer looked at patients who responded to induction chemotherapy then randomized between surgical resection versus radiation and found that the results were the same
Treatment Median Survival Survival/2 years Survival/5 years
Surgery 16.4 months 35% 16%
Radiation 17.5 months 41% 13%
A randomized trial of radical surgery (S) versus thoracic radiotherapy (TRT) in patients (pts) with stage IIIA-N2 non-small cell lung cancer (NSCLC) after response to induction chemotherapy (ICT) (EORTC 08941)

Background: The optimal locoregional treatment -TRT or S- following systemic ICT of pts with stage IIIA-N2 NSCLC is unclear. 5-year survival rate in uncontrolled series of either modality varies between 5-25%. Methods: selected pts with histological or cytological proven stage IIIA-N2 NSCLC were given 3 cycles of platinum-based ICT. Responding pts were then randomized between S: radical resection with lymph node dissection and optional postoperative radiotherapy (PORT), or TRT: at least 40 Gy in 2 Gy daily fractions on the mediastinum with a boost to at least 60 Gy on the involved field (IF). In order to observe an increase of 5-year overall survival (OS) from 15 (TRT) to 25% (S), 292 events out of 358 randomized pts had to be observed (log rank test, power 80%, type I error 5%). Secondary endpoints were progression free survival (PFS) and toxicity. Results: ICT achieved an average response rate of 61.5% (95% CI 57.6-65.5) among the 572 registered pts who started protocol treatment. Of these, 333 were randomized (167 to S and 166 to TRT), having the following characteristics: median age 62 years; male 74%; squamous/non-squamous: 39/61%; T1/2/3: 12/72/15%. In the 154 operated pts, the following rates were observed: exploratory thoracotomy: 14%; radical resection: 51%; pathological downstaging: 42%; operative mortality: 4%; PORT 39%. Among 155 pts randomized to TRT and actually irradiated, median total treatment time was 43 days (15-60). CT- scan planning was used in 92%. The median total dose delivered to the normal mediastinum/IF was 40/60 Gy, respectively. Any kind of grade 3/4 toxicity occurred in 3.9% of irradiated TRT pts. With a median follow up of 72 months, median, 2 and 5 year OS for pts randomized to S and TRT are 16.4 vs.17.5 months, 35 vs. 41% and 16 vs. 13%, respectively (HR 0. 95, 95% CI 0.75-1.19). Median and 2y PFS for pts randomized to S and TRT are 9.0 vs.11.4 months and 27 vs. 24%, respectively (p= 0.6). Conclusion: In selected pts with proven stage IIIA-N2 NSCLC and a response to ICT, S improves neither OS nor PFS as compared to TRT