Non small cell lung cancer medical therapy stage III: Difference between revisions
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{{familytree | | | | | | | A01 | | | | | | | | A01=Where is the tumor located?}} | {{familytree | | | | | | | A01 | | | | | | | | A01=Where is the tumor located?}} | ||
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{{familytree | E03 | | | | | | | | | | | E04 | {{familytree | E03 | | | | | | | | | | | E04 | | | | | | E03=<div style="float: left; text-align: left;">Superior suculus tumor</div>|E04=<div style="float: left; text-align: left;">Proximal airway <br>OR<br> [[Chest wall]] <br>OR<br> [[Mediastinum]]</div>}} | ||
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{{familytree | F01 | | | | | F02 | | | | | | | | | F03 | {{familytree | F01 | | | | | F02 | | | | | | | | | F03 | | F01=<div style="float: left; text-align: left;">T3 (Invasion to adjacent structures), N0</div>|F02=<div style="float: left; text-align: left;">Preferred option: Surgery + pathological determination of microscopic residual [[tumor]]</div>|F03=<div style="float: left; text-align: left;">Neoadjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]] <br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]</div>}} | ||
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{{familytree | G01 | | | | | G03 | | | | | | | | | G04 | {{familytree | G01 | | | | | G03 | | | | | | | | | G04 | | | G01=<div style="float: left; text-align: left;">Neoadjuvant chemotherapy</div>|G02=T4|G03=<div style="float: left; text-align: left;">Are margins from the surgical piece positive or negative for residual [[tumor]]?</div>|G04=<div style="float: left; text-align: left;">Perform surgery + pathological determination of residual tumor</div>}} | ||
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{{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | {{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | | | H01=<div style="float: left; text-align: left;">Surgery + adjuvant [[Non small cell carcinoma of the lung chemotherapychemotherapy]]</div>|H03=Negative (R0)|H04=<div style="float: left; text-align: left;">Positive: Is the residual [[tumor]] microscopic (R1) or macroscopic (R2)</div>|H05=Are margins from the surgical piece positive or negative for residual [[tumor]]?}} | ||
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{{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | {{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | | I03=No|I04=Adjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]]|I05=Microscopic (R1)|I06=Macroscopic (R2)|I07=Negative (R0)|I08=Positive (R1-2)}} | ||
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{{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | {{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | | J01=Initiate neoadjuvant [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|J02=Initiate definitive [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|J03=[[Tumor]] resection + adjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]]<br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]], followed or not by [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy, followed by chemotherapy|Chemotherapy]]|J04=[[Tumor]] resection + adjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]]<br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|J05=Observation|J06=[[Tumor]] resection}} | ||
{{familytree/end}} | {{familytree/end}} | ||
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Revision as of 18:48, 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 III Non-Small Cell Lung Cancer
The algorithms for the treatment of stage III non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
Stage IIIA: T3, N1
Perform a pretreatment evaluation
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Where is the tumor located? | |||||||||||||||||||||||||||||||||||||||||||||||||
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 Non small cell carcinoma of the lung chemotherapychemotherapy | 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 | ||||||||||||||||||||||||||||||||||||||||||||||
IIIA: T4, N0-1
Perform a pretreatment evaluation
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Is the tumor resectable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Where is the tumor located? | Definitive chemotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Superior suculus | Proximal airway OR Chest wall OR<br Mediastinum | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initiate neoadjuvant chemotherapy + radiation therapy | Preferred option: Surgery + pathological determination of microscopic residual tumor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Perform a surgical evaluation: Is the tumor resectable? | Are margins from the surgical piece positive or negative for residual tumor? | Perform surgery + pathological determination of residual tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | Negative (R0) | Positive: Is the residual tumor microscopic (R1) or macroscopic (R2) | Are margins from the surgical piece positive or negative for residual tumor? | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Tumor extraction + adjuvant chemotherapy | Definitive chemotherapy + radiation therapy | 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stage IIIB
Perform a pretreatment evaluation
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Is the tumor T1-3 or is it T4? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
T1-3, N3 | T4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Does the infiltration to lymph nodes meet the criteria for N3 or are there findings suggestive of metastatic disease? | Is the infiltration to the mediastinal lymph nodes contralateral or are there findings suggestive of metastatic disease? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Metastatic disease | Findings suggestive of N3 | See treatment | Metastatic disease | Positive contralateral mediastinal node infiltration | Does the tumor infiltrated the ipsilateral mediastinal lymph nodes? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Click here for the treatment of metastatic disease | Definitive chemotherapy + radiation therapy | Click here for the treatment of metastatic disease | Definitive chemotherapy + radiation therapy | Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Definitive chemotherapy + radiation therapy | Click here for the stage IIIA treatment | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||