Non small cell lung cancer medical therapy stage III

Jump to: navigation, search

Non Small Cell Lung Cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Non Small Cell Lung Cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Staging

History and Symptoms

Physical Examination

Laboratory Findings

Imaging

Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings

Other Diagnostic Studies

Biopsy

Treatment

Management Approach

Stage I
Stage II
Stage III
Stage IV
Metastatic Cancer

Medical Therapy

Chemotherapy
Radiation Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Non small cell lung cancer medical therapy stage III On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Non small cell lung cancer medical therapy stage III

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Non small cell lung cancer medical therapy stage III

CDC on Non small cell lung cancer medical therapy stage III

Non small cell lung cancer medical therapy stage III in the news

Blogs on Non small cell lung cancer medical therapy stage III

Directions to Hospitals Treating Non small cell carcinoma of the lung

Risk calculators and risk factors for Non small cell lung cancer medical therapy stage III

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2] Maria Fernanda Villarreal, M.D. [3]

Overview

Therapies for non-small cell lung cancer stage III, depends on 4 categories; Resectable tumors, unresectable tumors, superior sulcus tumors, and tumors that invade the chest wall. Therapies for resectable tumors include surgery, neoadjuvant therapy, and adjuvant therapy. Alternatively, therapies for unresectable disease only include radiation therapy, and chemoradiation therapy. Therapies for superior sulcus tumors include radiation therapy alone, radiation therapy and surgery, concurrent chemotherapy with radiation therapy and surgery. Lastly, therapies for tumors that invade the chest wall include surgery, surgery and radiation therapy, radiation therapy alone, and chemotherapy combined with radiation therapy and/or surgery. The treatment of stage III non-small cell lung cancer will be contingent on the extension of the tumor. Chemotherapy and/or radiation therapy should be considered for patients with stage IIIB.

Medical Therapy for Stage III Non-Small Cell Lung Cancer

The algorithms for the treatment of stage III non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]

Stage IIIA: T3, N1

 
 
 
 
 
 
Perform a pretreatment evaluation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Where is the tumor located?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 


IIIA: T4, N0-1

 
 
 
 
 
 
 
 
 
 
 
 
 
Perform a pretreatment evaluation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the tumor resectable?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Where is the tumor located?
 
 
 
 
 
Definitive chemotherapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Superior suculus
 
 
 
 
 
 
 
 
 
 
 
 
Proximal airway
OR
Chest wall
OR
Mediastinum
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initiate neoadjuvant chemotherapy + radiation therapy
 
 
 
 
 
 
Preferred option: Surgery + pathological determination of microscopic residual tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform a surgical evaluation: Is the tumor resectable?
 
 
 
 
 
 
Are margins from the surgical piece positive or negative for residual tumor?
 
 
 
 
 
 
 
 
Perform surgery + pathological determination of residual tumor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
Negative (R0)
 
 
 
Positive: Is the residual tumor microscopic (R1) or macroscopic (R2)
 
 
 
 
 
Are margins from the surgical piece positive or negative for residual tumor?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tumor extraction + adjuvant Chemotherapy
 
Definitive chemotherapy + radiation therapy
 
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
 


Stage IIIB

 
 
 
 
 
 
 
 
 
 
 
Perform a pretreatment evaluation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the tumor T1-3 or is it T4?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
T1-3, N3
 
 
 
 
 
 
 
 
 
 
 
T4
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the infiltration to lymph nodes meet the criteria for N3 or are there findings suggestive of metastatic disease?
 
 
 
 
 
 
 
 
 
 
 
Is the infiltration to the mediastinal lymph nodes contralateral or are there findings suggestive of metastatic disease?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Metastatic disease
 
Findings suggestive of N3
 
See treatment
 
Metastatic disease
 
Positive contralateral mediastinal node infiltration
 
 
 
Does the tumor infiltrated the ipsilateral mediastinal lymph nodes?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Click here for the treatment of metastatic cancer
 
Definitive chemotherapy + radiation therapy
 
 
 
 
 
Click here for the treatment of metastatic cancer
 
Definitive chemotherapy + radiation therapy
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Definitive chemotherapy + radiation therapy
 
Click here for the stage IIIA treatment
 

References


Linked-in.jpg