Page 60 - NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer

60 NCCN Guidelines for Patients®: Non-Small Cell Lung Cancer
Version 1.2013
Part 7: Treatment by cancer stage
This chart maps the treatment for stage IIB invasive tumors.
These tumors have grown into the chest wall or bronchus,
but the cancer hasn’t spread to lymph nodes. Treatment
options depend on into which tissues the primary tumor has
grown.
A superior sulcus tumor starts at the top of the lung
and easily grows into the chest wall. For these tumors,
concurrent chemoradiation is used to shrink the tumor
to make surgery easier. Concurrent chemoradiation is
chemotherapy given at the same time as radiation therapy.
After surgery, chemotherapy is recommended.
No treatment before surgery is the preferred option
for other tumors that have grown into the chest wall or
bronchus. Other options are concurrent chemoradiation
or chemotherapy alone followed by surgery. Adjuvant
treatment is based on the surgical results. If the surgical
margins are cancer-free, chemotherapy is needed unless
you had it before surgery.
When the margins have cancer, one option is to have
a second surgery followed by chemotherapy unless
you had it before surgery. The second option is to have
chemoradiation and then chemotherapy unless you had it
before surgery. Sequential chemoradiation—chemotherapy
followed by radiation therapy—is given when the cancer
cells can’t be seen. Concurrent chemoradiation is given
when the cancer can be seen without a microscope.
Primary treatment Pre-treatment test results
Stage IIB
invasive
Superior
sulcus tumor
Growth into
chest wall
Growth into
bronchus
Lung tumor and
lymph node surgery Chemoradiation
Lung tumor and
lymph node surgery
None (Preferred)
Chemotherapy
Neoadjuvant
treatment
Chemoradiation, or
Adjuvant treatment
Chemotherapy
Cancer in
margins?
Chemotherapy if none before
Surgery + chemotherapy
if none before, or
Chemoradiation + chemotherapy
if none before
No
Yes
Surgical
results
Stage IIB invasive tumors