Onkologie. 2025:19(5):268-274 | DOI: 10.36290/xon.2025.049

Treatment of inoperable stage III non-small cell lung cancer

Milada Zemanová

Onkologická klinika, 1. LF UK a VFN, Praha

Antitumor immunotherapy using checkpoint inhibitors brings significant improvement in treatment outcomes for patients with stage III NSCLC. To determine the treatment strategy in stage III, multidisciplinary team decision-making is necessary with the most precise definition of operable vs. inoperable cases. In the case of inoperable stage III, consolidation treatment with immunotherapy is the standard with the condition of PD-L1 expression above 1 %. One-year treatment after concomitant chemoradiothe­rapy significantly increases the chance of long-term survival and has also been shown to significantly prolong the time to disease recurrence. In inoperable and marginally resectable patients, new approaches are now in advanced stages of testing, such as early concomitant immuno-chemo-radiotherapy or induction treatment with chemoimmunotherapy before radiation with subsequent immune consolidation. In inoperable patients with EGFR mutations, concomitant chemoradiotherapy is still the standard, immunotherapy does not provide benefit, but immediately following targeted therapy with osimertinib significantly reduces the risk of recurrence, especially in the brain, and a trend towards prolonged survival is observed. In a significant group of stage III patients who are inoperable and cannot be irradiated with a radical dose, immunotherapy alone is an option, especially in the case of high PD-L1 expression.

Keywords: non-small cell lung cancer, stage III, immunotherapy, concurrent chemoradiotherapy.

Accepted: November 25, 2025; Published: December 15, 2025  Show citation