Non small cell lung cancer medical therapy stage II: Difference between revisions
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* If not done, perform [[pulmonary function tests]]<br> | * If not done, perform [[pulmonary function tests]]<br> | ||
* Perform [[bronchoscopy]] (if possible intraoperative)<br> | * Perform [[bronchoscopy]] (if possible intraoperative)<br> |
Revision as of 15:16, 24 June 2014
Non Small Cell Lung Cancer Microchapters |
Differentiating Non Small Cell Lung Cancer from other Diseases |
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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
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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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||