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

74 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Other invasive tumors Other stage III tumors can be invasive like superior sulcus tumors. These other tumors have grown into the chest wall, bronchi, or mediastinum. For initial treatment, options depend on if you are able to have surgery. Surgery . If surgery is an option, surgery alone is the preferred option of NCCN experts. Removal of the tumor and lymph nodes is advised to try to cure the cancer. Other options are chemoradiation or chemotherapy to shrink the cancer before surgery. After surgery, adjuvant treatment will be given. This treatment is given to reduce the chances of the cancer returning. If not received before, chemotherapy is advised if the surgical margins are cancer-free. Otherwise, you can start your survivorship plan. When the margins have cancer, a second surgery is an option. If not received before, chemotherapy may follow surgery. If prior radiation, you may receive a boost to improve treatment results. When the margins have cancer, a second option is chemoradiation if not received before. These two types of treatment can be given at the same time. They may also be given back-to-back if cancer in the margins can only be seen with a microscope. Chemoradiation . You may be unable or refuse to have surgery. In this case, chemoradiation is an option. These two types of treatment should be received at the same time. If the cancer does not worsen after 2 or more cycles of chemoradiation, durvalumab may be received. It may also slow down the growth of the cancer. Guide 14. N0 or N1 disease continued Other invasive tumors What are the options for initial treatment? Margin status What are the options after initial treatment? • Surgery (preferred) No cancer in the margins • Chemotherapy Cancer in margins that is only seen with a microscope • Another surgery + chemotherapy • Chemoradiation (same time or back-to-back) Cancer in margins that is seen with the naked eye • Another surgery + chemotherapy • Chemoradiation (at the same time) • Chemoradiation (at the same time) + surgery No cancer in the margins • Start survivorship plan Cancer in the margins • Another surgery • Chemotherapy + surgery No cancer in the margins • Start survivorship plan Cancer in the margins • Another surgery • Chemoradiation (at the same time) • Durvalumab 6 Non-metastatic cancer One primary tumor – Stage III

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