Adenocarcinoma of the lung medical therapy stage II

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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]
 
 
  • T1a-b, 2a, N1
  • T2b, N0
  • T3 Tumor larger than 7 cm (not invasive)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform a pretreatment evaluation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the location of the tumor?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Superior suculus tumor
 
 
 
 
 
 
 
 
 
 
Proximal airway
OR
Chest wall
OR
Mediastinum
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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

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

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