American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred treatment approach for most patients with stage III NSCLC with mediastinal lymph node involvement?

1. Combined chemoradiation therapy with curative intent

2. Surgical resection only

3. Radiation therapy alone

4. Experimental drug therapy

The correct answer is: Combined chemoradiation therapy with curative intent

The preferred treatment approach for most patients with stage III non-small cell lung cancer (NSCLC) that has mediastinal lymph node involvement is combined chemoradiation therapy with curative intent. This treatment strategy is typically utilized because stage III NSCLC is considered locally advanced and often presents with regional lymph node involvement, which complicates the disease and reduces the likelihood of successful surgical resection. In this context, combined chemoradiation therapy aims to maximize the efficacy of treatment by addressing both the primary tumor and any involved lymph nodes with chemotherapy and radiation concurrently. This approach helps to shrink the tumors, potentially making surgical options more viable later on, and enhances the overall survival rates for patients with this advanced stage of cancer. Surgical resection alone is generally not considered adequate for patients with stage III NSCLC with lymph node involvement due to the high risk of residual disease and poor outcomes. Radiation therapy alone does not provide the systemic treatment necessary to target micrometastatic disease, which can be present in stage III cases. While experimental drug therapy may be a consideration in certain clinical trials or specific scenarios, it is not the first-line treatment for most patients with this diagnosis. Hence, combined chemoradiation therapy remains the standard approach for these patients