NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer - page 64

NCCN Guidelines for Patients
: Non-Small Cell Lung Cancer
Version 1.2014
Part 7: Treatment by cancer stage
If no cancer growth, surgery + radiation
therapy if none before ± chemotherapy
Initial treatment
Test results
Adjuvant treatment
T1, N2
T2, N2
T3, N2
Chemotherapy ±
radiation therapy
N2 disease
found during
prior surgery
T4, N2, or
T1–T4, N3
Margin status
If local growth, radiation therapy if
none before ± chemotherapy
No cancer in margins
Sequential chemotherapy + radiation therapy
Cancer not seen with naked eye
Cancer seen with naked eye
Concurrent or sequential chemoradiation
Concurrent chemoradiation
Stage III tumors without invasion
N2 and N3 disease
This chart maps the treatment for stage III (N2 or N3)
tumors without invasion. Cancer that has spread to the
mediastinal lymph nodes is scored N2. Cancer spread to
the lymph nodes near the lung without the primary tumor
or to the supraclavicular or scalene nodes is scored N3.
N2 disease may be found only after surgery for stage I,
II, or III (T3, N1) cancer. In this case, adjuvant treatment
is based on the surgical results. If the surgical margins
are cancer-free, chemotherapy followed by radiation
therapy is recommended. If the margins have cancer,
treatment options are based on whether the cancer
can’t be seen with the naked eye (microscopic) or can
be seen (macroscopic). Microscopic cancer is found
with a microscope. For cancer not seen by the naked
eye, chemotherapy may be given at the same time
as radiation (concurrent) or beforehand (sequential).
Concurrent chemoradiation is the option for cancer that
can be seen with the naked eye.
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