Adenocarcinoma of the lung medical therapy stage II
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Adenocarcinoma of the Lung Microchapters |
Differentiating Adenocarcinoma of the Lung from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]
Stage II
Stage IIA
- Shown below is the algorithm on the treatment of the stage IIA non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
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Perform a pretreatment evaluation
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Does the pathological evaluation showed positive disease in the mediastinal lymph nodes? | |||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||
Click here for the stage III treatment | Is the tumor operable? | ||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||
Surgical resection + lymph node dissection | Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodes and intrapulmonar nodes (N1)? | ||||||||||||||||||||||||||||||
If lymph node extension is detected initiate neoadjuvantchemotherapy + radiation therapy | Yes | No | |||||||||||||||||||||||||||||
chemotherapy + radiation therapy | radiation therapy with stereotactic ablative radiotherapy Adjuvant Chemotherapy should be added for high-risk stages | ||||||||||||||||||||||||||||||
Stage IIB
- Shown below is the algorithm on the treatment of the stage IIB non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.
Perform a pretreatment evaluation
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What is the location of the tumor? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Superior suculus tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
T3 (Invasion to adjacent structures), N0 | Preferred option: Surgery + pathological determination of microscopic residual tumor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Neoadjuvant chemotherapy | Are margins from the surgical piece positive or negative for residual tumor? | Perform surgery + pathological determination of residual tumor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgery + adjuvant chemotherapy | Negative (R0) | Positive: Is the residual tumor microscopic (R1) or macroscopic (R2) | Are margins from the surgical piece positive or negative for residual tumor? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adjuvant chemotherapy | Microscopic (R1) | Macroscopic (R2) | Negative (R0) | Positive (R1-2) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tumor resection + adjuvant chemotherapy OR chemotherapy + radiation therapy, followed or not by chemotherapy | Tumor resection + adjuvant chemotherapy OR chemotherapy + radiation therapy | Observation | Tumor resection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx