SandboxAlonso

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Superior suculus tumor

 

 

 

 

 

 

 

Preferred option: Surgery + pathological determination of microscopic residual tumor

 

 

 

 

 

 

 

 

Neoadjuvant Chemotherapy
OR
Chemotherapy + radiation therapy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the tumor larger than 7 cm or invaded adjacent structures (T3) with or without invasion of ipsilateral peribronchial or hiliar nodes (N1)?
OR
Has the tumor has estended to any of the following:

• Carina
  
• Esophagus
  
• Great vessels
  
• Heart
  
• Laryngeal nerve
  
• Mediastinum
  
• Trachea
  
• Nodules in a different ipsilateral lobe

 

 

 

 

 

 

 

Are margins from the surgical piece positive or negative for residual tumor?

 

 

 

 

 

 

 

 

Perform surgery + pathological determination of residual tumor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T3, N0-1

 

 

 

T4

 

Negative (R0)

 

 

 

Positive: Is the residual tumor microscopic (R1) or macroscopic (R2)

 

 

 

 

 

Are margins from the surgical piece positive or negative for residual tumor?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initiate neoadjuvant chemotherapy + radiation therapy

 

 

 

Is the tumor resectable?

 

Adjuvant chemotherapy

 

Microscopic (R1)

 

Macroscopic (R2)

 

Negative (R1)

 

Positive (R1-2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surgery + adjuvant chemotherapy

 

Yes

 

No

 

 

 

Tumor resection + adjuvant chemotherapy
OR
Chemotherapy + radiotherapy

 

Tumor resection + adjuvant chemotherapy
OR
Chemotherapy + radiotherapy

 

Observation

 

Tumor resection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initiate neoadjuvant chemotherapy + radiation therapy

 

Initiate definitive chemotherapy + radiation therapy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Perform a surgical evaluation: Is the tumor resectable?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tumor extraction + adjuvant chemotherapy

 

 

 

Definitive chemotherapy + radiation therapy