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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

Unresectable stage IIIB NSCLC can be encompassed in a radical radiation field. ECOG performance status is 2. The thoracic MDT judges that platinum chemotherapy and radical radiotherapy are each feasible, but concurrent delivery is not. Which curative-intent plan best fits these constraints?

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Correct answer: E — Sequential platinum-based chemotherapy and radical thoracic radiotherapy

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

D is correct. Concurrent chemoradiotherapy offers the strongest disease-control evidence for fit stage III NSCLC, but sequential platinum chemotherapy and radical radiotherapy is a recognised curative-intent alternative when both modalities are feasible and concurrent toxicity is not. Maintenance pemetrexed is not a substitute for definitive combined-modality treatment. Palliative-dose radiation gives up the stated radical opportunity, durvalumab alone does not provide definitive local treatment, and full-intensity concurrent treatment contradicts the MDT fitness assessment. Consolidation immunotherapy after sequential treatment is evolving and must follow current commissioning and eligibility rather than being assumed from PACIFIC.

Reference: UK review of stage III NSCLC treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC7735212/