Page 61 - NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer

61 NCCN Guidelines for Patients® : Non-Small Cell Lung Cancer
Version 1.2013
Part 7: Treatment by cancer stage Par t 1
Par t 2
Par t 3
Par t 4
Par t 5
Par t 6
Par t 7
Par t 8
Par t 9
7.3 Stage III treatments
Radiation therapy if none
before ± chemotherapy
Primary treatment Pre-treatment
test results
Adjuvant treatment
T1, N2
T2, N2
T3, N2 Chemotherapy ±
radiation therapy
Chemoradiation
N2 disease (Prior surgery)
Neoadjuvant
treatment
(preferred)
Chemoradiation T4, N2
T1 – T4, N3
Surgical
results
Surgery if no cancer growth
Cancer in
margins?
No
Yes
Chemotherapy + radiation therapy
Chemoradiation + chemotherapy
T3, N1
T4, N0
T4, N1
Lung tumor and
lymph node surgery
If local growth, radiation therapy
if none before ± chemotherapy
You may have stage III lung cancer based on the staging
tests. Or you may have been upstaged to stage III after
surgery. Stage IIIA is often defined by cancer spread to
mediastinal nodes, presence of secondary tumors, or tumor
growth into the mediastinum, neck, or spine. Stage IIIB is
often defined by cancer that has spread to lymph nodes in
or near the other lung or above the collarbone.
Stage III tumors without invasion
This chart maps the treatment for stage III tumors
without invasion. These tumors have not grown into
nearby structures, such as the chest wall. There may be
secondary tumors in the lung with the primary tumor.
Surgery is an option for T3 and T4 tumors without cancer
spread to the mediastinal nodes (N0 or N1). Adjuvant
treatment is based on the surgical results. If the surgical
margins are cancer-free, chemotherapy with radiation
therapy is recommended. When the margins have
cancer, chemoradiation followed by chemotherapy is
recommended.