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

75 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 N2 disease Guide 15 lists treatment options for N2 disease. N2 nodes are between the lungs but next to the lung with cancer. Some are right below the windpipe. Initial treatment There are two options for initial treatment. Chemoradiation is one option. These two types of treatments should be given at the same time. Chemoradiation may greatly reduce tumor size. 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. Your doctor may decide that induction treatment is an option. It is used only under certain conditions. These conditions include T1–T3 tumors and no invasion. In such cases, chemotherapy with or without radiation therapy is advised. Induction treatment may stop the cancer from getting worse. If induction treatment works, surgery may be received. Post-initial treatment for N2 at diagnosis More treatment is advised to improve the results of initial treatment. After chemoradiation, durvalumab may be received. 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. You may have received induction chemotherapy with or without surgery. After induction treatment or surgery, radiation therapy is advised if not received before. You may receive more chemotherapy before radiation therapy. Adjuvant treatment for N2 found after surgery Sometimes N2 disease is found only after surgery. Adjuvant treatment is given to reduce the chances of the cancer returning. Options are based on if there’s cancer in the surgical margins. If there’s no cancer, chemotherapy alone or chemoradiation given back- to-back is an option. When the margins have cancer, chemoradiation is an option. 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. Guide 15. Treatment for N2 disease Initial treatment What are the options? • Chemoradiation (at the same time) • Induction chemotherapy ± radiation therapy ◦◦ If no cancer growth, surgery may be an option ◦◦ If local growth, start post-initial treatment ◦◦ If metastasis, read Part 7 Post-initial treatment for N2 at diagnosis Initial treatment What are the options for the next treatment? Chemoradiation • Durvalumab Induction chemotherapy • Adjuvant radiation therapy (if not received before) ± chemotherapy Adjuvant treatment for N2 found after surgery Margin status What are the options for the next treatment? No cancer in the margins • Chemotherapy • Chemoradiation (back-to-back) 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) 6 Non-metastatic cancer One primary tumor – Stage III

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