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

73 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Superior sulcus tumors Superior sulcus tumors start at the top of the lung. They easily grow into the chest wall. They are invasive cancers. Treatment options are based on if you can have surgery. Surgery is likely an option for T3 tumors but may not be for T4 tumors. In either case, chemoradiation is the first treatment given. Chemoradiation may shrink the cancer enough for surgery. The tumor will be re-assessed using imaging tests. A chest CT with or without contrast is advised. PET/CT may also be used. If surgery is still not an option, finish chemoradiation. After surgery, more chemotherapy is advised. It will reduce the chances of the cancer returning. The tumor may have not shrunk enough. In this case, you may complete radiation therapy. More chemotherapy is advised. If surgery wasn’t received, durvalumab may be an option. It is given if the cancer does not worsen after 2 or more cycles of chemoradiation. It may also slow down the growth of the cancer. Guide 14. Treatment for N0 or N1 disease* Tumors without invasion What are the options for initial treatment? Margin status What are the options after initial treatment? • Lung tumor and lymph node surgery No cancer in the margins • Chemotherapy Cancer in margins that is only seen with a microscope • Chemoradiation (same time or back-to-back) Cancer in margins that is seen with the naked eye • Chemoradiation (at the same time) • Chemoradiation (at the same time) • Durvalumab Superior sulcus tumors What are the options for initial treatment? Surgery status What are the options after initial treatment? • Chemoradiation (at the same time) Surgery is an option • Chemotherapy • Chemoradiation (at the same time) Surgery is not an option • Complete radiation therapy + chemotherapy + durvalumab • Chemoradiation (at the same time) • Durvalumab *Guide 14 continued on page 74 6 Non-metastatic cancer One primary tumor – Stage III

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