Stage IIIa non-small cell lung cancer remains categorically a heterogeneous hodgepodge without clear prospective mandates for clinical care. Poor outcome ensues for patients with mediastinal node-positive cancer when treated with surgery alone, but we are unclear how to define subsets that might benefit from surgery. This article reviews significant trials of surgery and chemoradiotherapy, including those using induction chemotherapy for stage III patients. While many continue to believe that chemotherapy without RT may provide equivalent pathologic complete response and survival rates, there is very little apparent difference in survival between patients managed with surgery or those managed to a higher dose of radiotherapy with concurrent chemotherapy (using an established chemotherapy regimen, 2-dimensional radiotherapy treatment planning, and a dose of only 61 Gy). If there is any benefit to surgery in the IIIa as currently staged, the benefit is very small and is counterbalanced by operative risk.

中文翻译：

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多数IIIa非小细胞肺癌的手术病例。

IIIa期非小细胞肺癌在分类上仍然是异质杂物，没有明确的临床治疗前瞻性要求。当单独进行手术治疗时，纵隔淋巴结阳性癌症患者的预后较差，但我们尚不清楚如何定义可能受益于手术的亚型。本文回顾了有关外科手术和化学放疗的重要试验，包括对III期患者进行诱导化疗的试验。尽管许多人继续认为没有放疗的化疗可以提供同等的病理完全缓解率和生存率，但是在接受手术治疗的患者或接受并发化疗的更高剂量放疗的患者（使用既定的化疗方案）之间，生存率差异不大，二维放射治疗计划，且剂量仅为61 Gy）。如果目前分期进行的IIIa手术有任何益处，则益处非常小，并且可以通过手术风险来抵消。