Non small cell lung cancer Stage 3a or 3b

nylagirl Member Posts: 1

My relative was diagnosed with non small cell lung cancer. The diagnosis started at 3a but now it might be 3b, they are unsure. He had a tumor in one lung, 3 cm, and then several lymph nodes are cancerous. The nodes are on the same side as the tumor as well as in the media-stinum. There were small lymph nodes on the opposite side from the tumor which were marked suspicious which is why there is a question of 3a or 3b. Initially they said they were going to do concurrent radiation and chemotherapy but recently they told us that the tumor is too far away from the lymph nodes so it might be dangerous to radiate all the nodes and the tumor at the same time so they need to separate out the lymph nodes to radiate regularly at the same time as the chemo but then do the tumor separately with SBRT. They said that if they continued to do all the radiation at once, it could be dangerous. So now they are trying to figure out if it's better to do the concurrent radiation and chemo of the lymph nodes first, do nothing to the tumor during that time and then once that regiment is over (about 7 weeks), give one week rest and then  go to the SBRT for the tumor Or do do the SBRT first, give a week break and then do the concurrent radiation and chemo after.  


I have several questions

  - I can't find any research online about whether it is better to do concurrent radiation and chemo and THEN SBRT or to do SBRT first followed by the concurrent chemo and radiation. 

 - I am trying to figure out whether it is better to zap the primary tumor first whereby postponing the start of the concurrent chemotherapy and chemotherapy or go with the concurrent chemo and radiation first to hit the cancerous lymph nodes but take the risk of the primry tumor enlarging or metastasizing before they get back to radiating it. 

- I am trying to understand if it is more likely that a primary tumor in the lung would metastasize or more likely that the cancerous lymph nodes would metastasize? And is it more usual that primary tumors spread faster than lymph nodes or visa versa?


Thanks for any help or comments.


  • Ex_Rock_n_Roller
    Ex_Rock_n_Roller Member Posts: 281 Member
    This is strictly a semi-educated guess ...

    ... but since the lymph system is "the river that bathes the cells," I would think it would make some sense to do the concurrent radio and chemo on the lymph nodes first. If the cancer is out there, it's already on the loose, so wondering about whether the main tumor is going to metastasize is beside the point: it already has.

    Note: I am not a doctor, nor do I play one on TV.

    Regarding the general advisability of concurrent radio and chemo, I believe it has been shown that there is a slight survival advantage to doing both at once rather than piecemeal.

    Best of luck, whatever the choice turns out to be.