Non small cell lung cancer medical therapy stage I
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Surgical resection with mediastinal, peribronchial and perihiliar lymph node dissection is the preferred option. If the pathological evaluation of the dissected lymph nodes is positive to malignant neoplastic cells, the patient should be treated according to the Stage III treatment algorithm. If the tumor is inoperable, stereotactic ablative radiation therapy should be administered.
Medical Therapy for Stage I Non-Small Cell Lung Cancer
Shown below is the algorithm on the treatment of the stage I non-small cell lung cancer based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
In the tumor central o peripheral? | |||||||||||||||||||||||||||||||||||||||||||
Peripheral | Central | ||||||||||||||||||||||||||||||||||||||||||
Is the tumor T1 or T2a? | |||||||||||||||||||||||||||||||||||||||||||
T1ab, N0 | T2a, N0 | T1ab-2a, N0 | |||||||||||||||||||||||||||||||||||||||||
Perform a pretreatment evaluation
| Perform a pretreatment evaluation | ||||||||||||||||||||||||||||||||||||||||||
Does the pathological evaluation showed positive disease in the mediastinal lymph nodes? | Does the pathological evaluation showed positive disease in the mediastinal lymph nodes? | ||||||||||||||||||||||||||||||||||||||||||
Yes | No | Yes | No | ||||||||||||||||||||||||||||||||||||||||
Click here for the stage III treatment | Is the tumor operable? | Click here for the stage III treatment | Is the tumor operable? | ||||||||||||||||||||||||||||||||||||||||
Yes | No | Yes | No | ||||||||||||||||||||||||||||||||||||||||
Surgical resection + lymph node dissection | stereotactic ablative radiation therapy | Surgical resection + lymph node dissection | Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodesand intrapulmonar nodes (N1)? | ||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||
chemotherapy + radiation therapy | stereotactic ablative radiation therapy Adjuvant chemotherapy should be added for high-risk stages | ||||||||||||||||||||||||||||||||||||||||||