Non small cell lung cancer medical therapy stage II: Difference between revisions
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==Medical Therapy for Stage II Non-Small Cell Lung Cancer== | ==Medical Therapy for Stage II Non-Small Cell Lung Cancer== | ||
===Stage IIA=== | |||
Shown below is the algorithm on the treatment of the stage IIA non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | |||
{{familytree/start}} | |||
{{familytree | | | B01 | | | B01=<div style="float: left; text-align: left; width: 14em; padding:1em;"> | |||
* T1a-b, 2a, N1<br> | |||
* T2b, N0<br> | |||
* T3 Tumor larger than 7 cm (not invasive)</div>}} | |||
{{familytree | | | |!| | | | | | | | |}} | |||
{{familytree | | | C01 | | | | | C01=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''Perform a pretreatment evaluation'''<br> | |||
* If not done, perform [[pulmonary function tests]]<br> | |||
* Perform [[bronchoscopy]] (if possible intraoperative)<br> | |||
* Perform a pathological [[lymph node]] evaluation<br> | |||
* If not done, order [[PET]] scan or [[CT scan]] | |||
</div>}} | |||
{{familytree | | | |!| | | |}} | |||
{{familytree | | | D01 | | | |D01=Does the pathological evaluation showed positive disease in the [[mediastinal]] [[lymph nodes]]?}} | |||
{{familytree | |,|-|^|-|.| | | |}} | |||
{{familytree | E01 | | E02 | | | E01=Yes|E02=No}} | |||
{{familytree | |!| | | |!| | | | |}} | |||
{{familytree | F01 | | F02 | | | F01=[[Non small cell carcinoma of the lung#Stage III|Click here for the stage III treatment]]|F02=Is the tumor operable?}} | |||
{{familytree | | | |,|-|^|-|.| | |}} | |||
{{familytree | | | G01 | | G02 | | G01=Yes|G02=No}} | |||
{{familytree | | | |!| | | |!| | | |}} | |||
{{familytree | | | H01 | | H02 | | | | H01=Surgical resection + [[lymph node]] dissection|H02=Does the patient presents metastasis to ipsilateral [[Tracheobroncuial lymph nodes|peribronchial]] and/or [[Tracheobroncuial lymph nodes|hiliar nodes]] and intrapulmonar nodes (N1)?}} | |||
{{familytree | | | | | |,|-|^|-|.| | | |}} | |||
{{familytree | | | | | I01 | | I02 | | | | | I01=Yes|I02=No|I03=Initiate neoadjuvant [[chemotherapy]] + [[radiation therapy]]|I04=Is the tumor resectable?}} | |||
{{familytree | | | | | |!| | | |!| | |}} | |||
{{familytree | | | | | J01 | | J02 | | J01=[[Chemotherapy]] + [[radiation therapy]]|J02=[[Radiation therapy]] with stereotactic ablative radiotherapy<br>Adjuvant [[chemotherapy]] should be added for high-risk stages}} | |||
{{familytree/end}} | |||
<br> | |||
===Stage IIB=== | |||
Shown below is the algorithm on the treatment of the stage IIB non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | |||
{{familytree/start}} | |||
{{familytree | | | | | | | C02 | | | | | | | | | | C02=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Perform a pretreatment evaluation'''<br> | |||
* If not done, perform [[pulmonary function tests]]<br> | |||
* Perform [[bronchoscopy]] (if possible intraoperative)<br> | |||
* Perform a pathological [[lymph node]] evaluation<br> | |||
* If not done, order [[PET]] scan or [[CT scan]]<br> | |||
* Perform a [[Brain tumor MRI|brain MRI]]<br> | |||
* Perform a spine [[MRI]] with thoracic inlet searching for superior suculus lesions and infiltration to the [[subclavian vessels]] or [[spine]]</div>}} | |||
{{familytree | | | | | | | |!| | | | | | | | | | | | |}} | |||
{{familytree | | | | | | | D02 | | | | | | | | | | | | | | | D02=What is the location of the [[tumor]]?}} | |||
{{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |}} | |||
{{familytree | E03 | | | | | | | | | | | E04 | | | | | | | | | | | | | E03=Superior suculus tumor|E04=<div style="float: left; text-align: left; width: 14em; padding:1em;">Proximal airway <br>OR<br> [[Chest wall]] <br>OR<br> [[Mediastinum]]</div>}} | |||
{{familytree | |!| | | | | | |,|-|-|-|-|-|^|-|-|-|-|.| | | | | |}} | |||
{{familytree | F01 | | | | | F02 | | | | | | | | | F03 | | | | | | | | | | | | | F01=T3 (Invasion to adjacent structures), N0|F02=<div style="float: left; text-align: left; width: 14em; padding:1em;">Preferred option: Surgery + pathological determination of microscopic residual [[tumor]]</div>|F03=<div style="float: left; text-align: left; width: 14em; padding:1em;">Neoadjuvant [[Chemotherapy]] <br>OR<br>[[Chemotherapy]] + [[radiation therapy]]</div>}} | |||
{{familytree | |!| | | | | | |!| | | | | | | | | | |!| | | | | | | |}} | |||
{{familytree | G01 | | | | | G03 | | | | | | | | | G04 | | | | | | G01=Neoadjuvant chemotherapy|G02=T4|G03=<div style="float: left; text-align: left; width: 10em; padding:1em;">Are margins from the surgical piece positive or negative for residual [[tumor]]?</div>|G04=<div style="float: left; text-align: left; width: 10em; padding:1em;">Perform surgery + pathological determination of residual tumor</div>}} | |||
{{familytree | |!| | | |,|-|-|^|-|-|.| | | | | | | |!| | | | | | | | | |}} | |||
{{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | | | | | | | | H01=Surgery + adjuvant [[chemotherapy]]|H03=Negative (R0)|H04=<div style="float: left; text-align: left; width: 10em; padding:1em;">Positive: Is the residual [[tumor]] microscopic (R1) or macroscopic (R2)</div>|H05=Are margins from the surgical piece positive or negative for residual [[tumor]]?}} | |||
{{familytree | | | | | |!| | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | |}} | |||
{{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | | | | I03=No|I04=Adjuvant [[chemotherapy]]|I05=Microscopic (R1)|I06=Macroscopic (R2)|I07=Negative (R0)|I08=Positive (R1-2)}} | |||
{{familytree | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}} | |||
{{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | | | | | | | | | | | | J01=Initiate neoadjuvant [[chemotherapy]] + [[radiation therapy]]|J02=Initiate definitive [[chemotherapy]] + [[radiation therapy]]|J03=[[Tumor]] resection + adjuvant [[chemotherapy]]<br>OR<br>[[Chemotherapy]] + [[radiation therapy]], followed or not by [[chemotherapy]]|J04=[[Tumor]] resection + adjuvant [[chemotherapy]]<br>OR<br>[[Chemotherapy]] + [[radiation therapy]]|J05=Observation|J06=[[Tumor]] resection}} | |||
{{familytree/end}} | |||
Revision as of 13:39, 24 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Medical Therapy for Stage II Non-Small Cell Lung Cancer
Stage IIA
Shown below is the algorithm on the treatment of the stage IIA non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
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Perform a pretreatment evaluation
| |||||||||||||||||||||||||||||
Does the pathological evaluation showed positive disease in the mediastinal lymph nodes? | |||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||
Click here for the stage III treatment | Is the tumor operable? | ||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||
Surgical resection + lymph node dissection | Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodes and intrapulmonar nodes (N1)? | ||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||
Chemotherapy + radiation therapy | Radiation therapy with stereotactic ablative radiotherapy Adjuvant chemotherapy should be added for high-risk stages | ||||||||||||||||||||||||||||
Stage IIB
Shown below is the algorithm on the treatment of the stage IIB non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
Perform a pretreatment evaluation
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What is the location of the tumor? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Superior suculus tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
T3 (Invasion to adjacent structures), N0 | Preferred option: Surgery + pathological determination of microscopic residual tumor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Neoadjuvant chemotherapy | Are margins from the surgical piece positive or negative for residual tumor? | Perform surgery + pathological determination of residual tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgery + adjuvant chemotherapy | Negative (R0) | Positive: Is the residual tumor microscopic (R1) or macroscopic (R2) | Are margins from the surgical piece positive or negative for residual tumor? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adjuvant chemotherapy | Microscopic (R1) | Macroscopic (R2) | Negative (R0) | Positive (R1-2) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tumor resection + adjuvant chemotherapy OR Chemotherapy + radiation therapy, followed or not by chemotherapy | Tumor resection + adjuvant chemotherapy OR Chemotherapy + radiation therapy | Observation | Tumor resection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||