Non small cell lung cancer medical therapy stage III: Difference between revisions
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{{familytree | {{familytree | | | | | | | | | | | | Z01 | | | | | | | | | Z01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Perform a pretreatment evaluation'''<br> | ||
* If not done, order [[PET]] scan or [[CT scan]]<br> | * If not done, order [[PET]] scan or [[CT scan]]<br> | ||
* Confirmation tests of [[lymph node]] infiltration stage:<br> | * Confirmation tests of [[lymph node]] infiltration stage:<br> | ||
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* Perform a [[Brain tumor MRI|brain MRI]]<br> | * Perform a [[Brain tumor MRI|brain MRI]]<br> | ||
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{{familytree | {{familytree | | | | | | | | | | | | |!| | | | | | |}} | ||
{{familytree | {{familytree | | | | | | | | | | | | A01 | | | | | | | | | A01=Is the [[tumor]] T1-3 or is it T4?}} | ||
{{familytree | {{familytree | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | |}} | ||
{{familytree | {{familytree | | | | | B01 | | | | | | | | | | | | B02 | | B01=T1-3, N3|B02=T4}} | ||
{{familytree | {{familytree | | | | | |!| | | | | | | | | | | | | |!| | |}} | ||
{{familytree | {{familytree | | | | | C01 | | | | | | | | | | | | C02 | | C01=Does the infiltration to [[lymph nodes]] meet the criteria for N3 or are there findings suggestive of [[metastatic disease]]?|C02=Is the infiltration to the [[mediastinal]] [[lymph nodes]] contralateral or are there findings suggestive of [[metastatic disease]]?}} | ||
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{{familytree | | | D01 | {{familytree | | | D01 | | | | D02 | | | | D03 | | | | | | D04 | | D01=Yes|D02=No|D03=Yes|D04=No}} | ||
{{familytree | |,|-|^|-|. | {{familytree | |,|-|^|-|.| | | |!| | | |,|-|^|-|.| | | | | |!| | | |}} | ||
{{familytree | E01 | | E02 | | {{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | | | E06 | | | | | E01=[[Metastatic disease]]|E02=Findings suggestive of N3|E03=See treatment|E04=[[Metastatic disease]]|E05=Positive contralateral [[mediastinal]] node infiltration|E06=Does the [[tumor]] infiltrated the ipsilateral [[mediastinal]] [[lymph nodes]]?}} | ||
{{familytree | |!| | | |! | {{familytree | |!| | | |!| | | | | | | |!| | | |!| | | |,|-|^|-|.| | |}} | ||
{{familytree | F01 | | F02 | | {{familytree | F01 | | F02 | | | | | | F03 | | F04 | | F05 | | F06 | | F01=[[Non small cell carcinoma of the lung medical therapy#Metastatic disease|Click here for the treatment of metastatic disease]]|F02=Definitive [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|F03=[[Non small cell carcinoma of the lung medical therapy#Metastatic disease|Click here for the treatment of metastatic disease]]|F04=Definitive [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|F05=Yes|F06=No}} | ||
{{familytree | {{familytree | | | | | | | | | | | | | | | | | | | | | |!| | | |!| |}} | ||
{{familytree | {{familytree | | | | | | | | | | | | | | | | | | | | | G01 | | G02 | | G01=Definitive [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|G02=[[Non small cell carcinoma of the lung medical therapy#Stage IIIA|Click here for the stage IIIA treatment]]}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 19:02, 24 June 2014
Non Small Cell Lung Cancer Microchapters |
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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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||