Adenocarcinoma of the lung medical therapy stage IV

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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 IV

  • The algorithms for the treatment of stage IV non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
 
 
 
 
 
 
Is pleural or pericardial effusion present (suggestive of M1a) or are findings suggestive of systemic metastasis (M1b) present?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
M1a
 
 
 
 
 
M1b: solitary site systemic metastasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform the following tests:
 
 
 
 
 
Perform the following tests:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the liquid extracted positive for malignant cells?
 
 
 
 
 
Are findings suggestive of adrenal metastasis or brain metastasis?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
Adrenal
 
Brain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Local therapy
  • Ambulatory catheter drainage
  • Pleurodesis
  • Mediastinal window

PLUS
Therapy for metastatic disease (click here for the treatment of metastatic cancer)

 
Treat according to tumor stage:
 
Perform a needle aspiration biopsy for metastasis confirmation
 
Surgical resection + adjuvant radiation therapy
Radiation therapy alone:

PLUS

Pathologic evaluation of surgical piece and lymph nodes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If the lung disease is curable, administer local therapy for the adrenal lesion:

OR
Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of metastatic cancer)

 
What is the TN stage of the lung tumor?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  • T1-2, No-1
  • T3, N0
 
  • T1-2, N2
  • T3, N1-2
  • N3, regardless of the T stage
  • T4 regardless of the N stage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of metastatic cancer)
 
 
 


References

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

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