Non small cell lung cancer medical therapy stage IV: Difference between revisions
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==Medical Therapy for Stage IV Non-Small Cell Lung Cancer== | ==Medical Therapy for Stage IV Non-Small Cell Lung Cancer== | ||
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{{familytree | | | | | | | A01 | | | | | A01=Is [[Pleural effusion|pleural]] or [[pericardial effusion]] present (suggestive of M1a) or are findings suggestive of systemic [[metastasis]] (M1b) present?}} | |||
{{familytree | | | |,|-|-|-|^|-|-|-|.| | |}} | |||
{{familytree | | | B01 | | | | | | B02 | B01=M1a|B02=M1b: solitary site systemic [[metastasis]]}} | |||
{{familytree | | | |!| | | | | | | |!| | | |}} | |||
{{familytree | | | C01 | | | | | | C02 | | | C01=<div style="float: left; text-align: left; width: 14em; padding:1em;">Perform the following tests:<br> | |||
* Perform [[thoracentesis]] and/or [[pericardiocenteis]]<br> | |||
* Perform a [[thoracoscopy]] if [[thoracocentesis]] is inconclusive | |||
</div>|C02=<div style="float: left; text-align: left; width: 14em; padding:1em;">Perform the following tests:<br> | |||
* [[Brain tumor MRI|Brain MRI]]<br> | |||
* [[Bronchoscopy]]<br> | |||
* Mediastinal [[lymph node biopsy]]<br> | |||
* If not previously done, [[PET scan]] or [[CT scan]]</div>}} | |||
{{familytree | | | |!| | | | | | | |!| | | | |}} | |||
{{familytree | | | D01 | | | | | | D02 | | | | D01=Is the liquid extracted positive for malignant cells?|D02=Are findings suggestive of [[adrenal]] metastasis or [[brain]] metastasis?}} | |||
{{familytree | |,|-|^|-|.| | | |,|-|^|-|.| | | |}} | |||
{{familytree | E01 | | E02 | | E03 | | E04 | | | E01=Yes|E02=No|E03=[[Adrenal]]|E04=[[Brain]]}} | |||
{{familytree | |!| | | |!| | | |!| | | |!| | |}} | |||
{{familytree | F01 | | F02 | | F03 | | F04 | | F01=<div style="float: left; text-align: left; width: 14em; padding:1em;">Local therapy<br> | |||
* Ambulatory catheter drainage<br> | |||
* [[Pleurodesis]]<br> | |||
* Mediastinal window<br> | |||
PLUS<br> | |||
Therapy for metastatic disease (click here for the treatment of local and systemic metastasis and neoplastic recurrence) | |||
</div>|F02=<div style="float: left; text-align: left; width: 14em; padding:1em;">Treat according to tumor stage:<br> | |||
* [[Non small cell carcinoma of the lung medical therapy#Stage I|I]]<br> | |||
* [[Non small cell carcinoma of the lung medical therapy#Stage II|II]]<br> | |||
* [[Non small cell carcinoma of the lung medical therapy#Stage III|III]]<br> | |||
</div>|F03=Perform a [[needle aspiration biopsy]] for metastasis confirmation|F04=<div style="float: left; text-align: left; width: 14em; padding:1em;">Surgical resection + adjuvant radiation therapy<br>Radiation therapy alone:<br> | |||
* Sterotactic radio surgery + Whole brain radiation therapy<br>OR<br> | |||
* Sterotactic radio surgery alone<br> | |||
PLUS<br> | |||
Pathologic evaluation of surgical piece and [[lymph nodes]]</div>}} | |||
{{familytree | | | | | | | | | |!| | | |!| | | | | | | |}} | |||
{{familytree | | | | | | | | | G01 | | G02 | | | | | | | G01=<div style="float: left; text-align: left; width: 14em; padding:1em;">If the [[lung]] disease is curable, administer local therapy for the [[adrenal]] lesion:<br> | |||
* Surgical [[adrenal]] resection<br>OR<br> | |||
* Radiation therapy<br> | |||
OR<br> | |||
Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence) | |||
</div>|G02=What is the TN stage of the lung [[tumor]]?}} | |||
{{familytree | | | | | | | | | | | |,|-|^|-|.| | |}} | |||
{{familytree | | | | | | | | | | | H01 | | H02 | | | | | H01=<div style="float: left; text-align: left; width: 14em; padding:1em;"> | |||
* T1-2, No-1<br> | |||
* T3, N0 | |||
</div>|H02=<div style="float: left; text-align: left; width: 14em; padding:1em;"> | |||
* T1-2, N2<br> | |||
* T3, N1-2<br> | |||
* N3, regardless of the T stage<br> | |||
* T4 regardless of the N stage</div>}} | |||
{{familytree | | | | | | | | | | | |!| | | |!| | | | | | |}} | |||
{{familytree | | | | | | | | | | | I01 | | I02 | | | | I01=<div style="float: left; text-align: left; width: 14em; padding:1em;"> | |||
* Surgical resection of lung [[tumor]] + adjuvant chemotherapy<br>OR<br> | |||
* Neoadjuvant chemotherapy + surgical resection or stereotactic ablative radiation therapy<br>OR<br> | |||
* Stereotactic ablative radiation therpay alone</div> | |||
|I02=<div style="float: left; text-align: left; width: 14em; padding:1em;">Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence)</div>}} | |||
{{familytree/end}} | |||
Revision as of 13:44, 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 IV Non-Small Cell Lung Cancer
Is pleural or pericardial effusion present (suggestive of M1a) or are findings suggestive of systemic metastasis (M1b) present? | |||||||||||||||||||||||||||||||||||||||||||||
M1a | M1b: solitary site systemic metastasis | ||||||||||||||||||||||||||||||||||||||||||||
Perform the following tests:
| Perform the following tests:
| ||||||||||||||||||||||||||||||||||||||||||||
Is the liquid extracted positive for malignant cells? | Are findings suggestive of adrenal metastasis or brain metastasis? | ||||||||||||||||||||||||||||||||||||||||||||
Yes | No | Adrenal | Brain | ||||||||||||||||||||||||||||||||||||||||||
Local therapy
PLUS | Perform a needle aspiration biopsy for metastasis confirmation | Surgical resection + adjuvant radiation therapy Radiation therapy alone:
PLUS | |||||||||||||||||||||||||||||||||||||||||||
What is the TN stage of the lung tumor? | |||||||||||||||||||||||||||||||||||||||||||||
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| Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of local and systemic metastasis and neoplastic recurrence) | ||||||||||||||||||||||||||||||||||||||||||||