Lung cancer with mediastinal lymph node involvement has a poor prognosis, especially when treated with surgery alone. Such cases are considered to be managed best by multimodality treatment. Some randomized trials showed positive results of induction chemotherapy and adjuvant chemotherapy in locally advanced lung cancer, but more evidence is needed to create the standard treatment for stage III lung cancer. A combination of chemotherapy and radiotherapy remain the standard of care for patients with obvious N2 disease, and the role of surgery following induction chemotherapy or chemo-radiotherapy in advanced stage III patients will be evaluated in phase III trials. Enrollment of patients in prospective clinical trials is strongly recommended to clarify unresolved issues in this clinical setting.