SandboxAlonso

Stage II

Has the tumor invaded adjacent structures, such as: chest walls, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium or bronchial tumor smaller than 2 cm?

NO T1a-b, 2a-b, N1 T2b, N0 T3 Tumor larger than 7 cm (not invasive)

Yes IIB: T3 (invasive tumor)

Perform a pretreatment evaluation If not done, perform pulmonary function tests Perform bronchoscopy (if possible intraoperative) Perform a pathological lymph node evaluation If not done, order PET scan or CT scan

Perform a pretreatment evaluation If not done, perform pulmonary function tests Perform bronchoscopy (if possible intraoperative) Perform a pathological lymph node evaluation If not done, order PET scan or CT scan Perform a brain MRI Perform a spine MRI with thoracic inlet searching for superior suculus lesions and infiltration to the subclavian vessels or spine

Does the pathological evaluation showed positive disease in the mediastinal lymph nodes?

What is the location of the tumor?

Yes

No

Superior suculus tumor

Proximal airway OR Chest wall OR Mediastinum

Click here for the stage III treatment

Is the tumor operable?

Superior suculus tumor

Yes

No

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

Surgical resection + lymph node dissection

Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodesand intrapulmonar nodes (N1)?

T3, N0-1

Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodesand intrapulmonar nodes (N1)?

Yes

No

Initiate neoadjuvant chemotherapy + radiation therapy

Is the tumor resectable?

Chemotherapy + radiation therapy

Radiotherapy with stereotactic ablative radiotherapy Adjuvant chemotherapy should be added for high-risk stages

Surgery + adjuvant chemotherapy

Yes

No

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