Non small cell lung cancer management: Difference between revisions

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==Overview==
==Overview==


The optimal management approach of non-small cell lung cancer will depend on a series of characteristics, that include: pre-treatment evaluation, location, and adequate [[Cancer staging|staging]]. Common treatment options for management of non-small cell lung cancer, include: [[surgery]], [[neoadjuvant chemotherapy]], [[Adjuvant therapy|adjuvant chemotherapy]], and [[radiation therapy]].
The optimal management approach of non-small cell lung cancer will depend on a series of characteristics, that include: pre-treatment evaluation, location, and adequate [[Cancer staging|staging]]. Common treatment options for management of non-small cell lung cancer include [[surgery]], [[neoadjuvant chemotherapy]], [[Adjuvant therapy|adjuvant chemotherapy]], and [[radiation therapy]].


==Management Approach==
==Management Approach==
*The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer
*The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer.<ref name="PDQ"> PDQ Adult Treatment Editorial Board. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032637/ Accessed on February 22, 2016 </ref> <small>To have a detailed information on the sequential management please click on each TNM stage in the table.</small>


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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Lung cancer]]
[[Category:Lung cancer]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Pulmonology]]
[[Category:Surgery]]

Latest revision as of 22:22, 23 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

The optimal management approach of non-small cell lung cancer will depend on a series of characteristics, that include: pre-treatment evaluation, location, and adequate staging. Common treatment options for management of non-small cell lung cancer include surgery, neoadjuvant chemotherapy, adjuvant chemotherapy, and radiation therapy.

Management Approach

  • The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer.[1] To have a detailed information on the sequential management please click on each TNM stage in the table.
Standard Treatment Options
Adapted from Non-Small Cell Lung Cancer Treatment (PDQ® 2016) [1]
Stage (TNM criteria) Standard Treatment Options
Stages IA and IB
  • Surgery
  • Radiation therapy
  • IB, if the tumor is >4cm, surgery and chemotherapy
Stages IIA and IIB
  • Surgery
  • Neoadjuvant chemotherapy
  • Adjuvant chemotherapy
  • Radiation therapy
Stage IIIA

Resected or resectable disease

  • Surgery
  • Neoadjuvant therapy
  • Adjuvant therapy

Unresectable disease

  • Radiation therapy
  • Chemoradiation therapy

Superior sulcus tumors

  • Radiation therapy alone
  • Radiation therapy and surgery
  • Concurrent chemotherapy with radiation therapy and surgery
  • Surgery alone (for selected patients)

Tumors that invade the chest wall

  • Surgery
  • Surgery and radiation therapy
  • Radiation therapy alone
  • Chemotherapy combined with radiation therapy and/or surgery
Stage IIIB
  • Sequential or concurrent chemotherapy and radiation therapy
  • Chemotherapy followed by surgery (for selected patients)
  • Radiation therapy alone
Stage IV
  • Cytotoxic combination chemotherapy (first line)
  • Combination chemotherapy with bevacizumab or cetuximab
  • EGFR tyrosine kinase inhibitors (first line)
  • EML4-ALK inhibitors in patients with EML-ALK translocations
  • Immune checkpoint inhibition with nivolumab for selected patients with squamous or nonsquamous metastatic

Maintenance therapy following first-line chemotherapy

  • Endobronchial laser therapy and/or brachytherapy (for obstructing lesions)
  • External-beam radiation therapy (primarily for palliation of local symptomatic tumor growth)
Recurrent
  • Radiation therapy (for palliation)
  • Chemotherapy or kinase inhibitors alone EGFR inhibitors in patients with/without EGFR mutations
  • EML4-ALK inhibitors in patients with EML-ALK translocations
  • Surgical resection of isolated cerebral metastasis (for highly selected patients)
  • Laser therapy or interstitial radiation therapy (for endobronchial lesions)
  • Stereotactic radiation surgery (for highly selected patients)

References

  1. 1.0 1.1 PDQ Adult Treatment Editorial Board. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032637/ Accessed on February 22, 2016