Page 62 - NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer

62 NCCN Guidelines for Patients®: Non-Small Cell Lung Cancer
Version 1.2013
Part 7: Treatment by cancer stage
Cancer spread to the mediastinal lymph nodes is scored
N2. N2 disease may be found only after surgery for
stage I, II, or III (T3, N1) cancer. In this case, adjuvant
treatment is the same as for T3, N1 disease.
N2 disease may be found by tests given before
treatment. In this case, concurrent chemoradiation is
strongly recommended. If surgery is desired, another
option is to have chemotherapy with or without radiation
therapy. If this treatment stops cancer growth, surgery
can be done. After surgery, you may have chemotherapy
followed by radiation therapy if you didn’t have it before.
If there’s cancer growth in or near the lung, radiation
therapy (if you didn’t have it before) with or without
chemotherapy is recommended.
Stage IIIB includes T4 tumors with N2 disease and
any tumor with N3 disease. Surgery is hardly ever
an option for stage IIIB cancers. Instead, concurrent
chemoradiation is strongly recommended.
Primary treatment Pre-treatment test results
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 III invasive tumors
Growth into
mediastinum
Unable to have
lung surgery Radiation therapy
Chemoradiation
T4, N0 or N1 that can’t
be treated with surgery
Chemotherapy
T3, N1
T4, N0
T4, N1
T3 or T4, N2
T3 or T4, N3