Adenocarcinoma of the lung medical therapy stage I

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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 I

  • 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
  • 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
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    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
     
     


    References

    1. Lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx

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