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| __NOTOC__
| | {{Image|Noninferiority and equivalency randomized controlled trials.jpg|right|350px|Noninferiority and equivalency randomized controlled trials.}} |
| {{Adenocarcinoma of the lung}} | |
| {{CMG}}; {{AE}} {{SC}}
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| ==Overview==
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| ==Medical Therapy==
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| ===Stage I===
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| 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.<ref name=nccn>Non-small cell lung cancer. National Comprehensive Cancer Network 2015. http://www.nccn.org/professionals/default.aspx</ref>
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | A01 | | |A01=In the [[tumor]] central o peripheral?}}
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| {{familytree | | | | | | |,|-|-|-|^|-|-|.| | | | |}}
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| {{familytree | | | | | | B01 | | | | | B02 | | | B01=Peripheral|B02=Central}}
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| {{familytree | | | | | | |!| | | | | | |!| | |}}
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| {{familytree | | | | | | C01 | | | | | |!| | | C01=Is the [[tumor]] T1 or T2a?}}
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| {{familytree | | | |,|-|-|^|-|-|.| | | |!| | | |}}
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| {{familytree | | | D01 | | | | D02 | | D03 | | | D01=T1ab, N0|D02=T2a, N0|D03=T1ab-2a, N0}}
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| {{familytree | | | |!| | | | | |`|-|v|-|'| | | |}}
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| {{familytree | | | E01 | | | | | | E02 | | | | E01='''Perform a pretreatment evaluation'''<br>
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| * If not done, perform [[pulmonary function tests]]<br>
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| * Perform [[bronchoscopy]] (if possible intraoperative)<br>
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| * Perform a pathological [[lymph node evaluation]]<br>
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| * If not done, order [[PET]] scan or [[CT scan]]
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| |E02='''Perform a pretreatment evaluation'''<br>
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| * If not done, perform [[pulmonary function tests]]<br>
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| * Perform [[bronchoscopy]] (if possible intraoperative)<br>
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| * Perform a pathological [[lymph node]] evaluation<br>
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| * If not done, order [[PET]] scan or [[CT scan]]}}
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| {{familytree | | | |!| | | | | | | |!| | | | |}}
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| {{familytree | | | F01 | | | | | | F02 | | | | | F01=Does the pathological evaluation showed positive disease in the mediastinal [[lymph nodes]]?|F02=Does the pathological evaluation showed positive disease in the mediastinal [[lymph nodes]]?}}
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| {{familytree | |,|-|^|-|.| | | |,|-|^|-|.| | |}}
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| {{familytree | G01 | | G02 | | G03 | | G04 | | G01=Yes|G02=No|G03=Yes|G04=No}}
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| {{familytree | |!| | | |!| | | |!| | | |!| | | |}}
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| {{familytree | H01 | | H02 | | H03 | | H04 | | | | H01=[[Non small cell carcinoma of the lung medical therapy stage III|Click here for the stage III treatment]]|H02=Is the [[tumor]] operable?|H03=[[Non small cell carcinoma of the lung medical therapy stage III|Click here for the stage III treatment]]|H04=Is the tumor operable?}}
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| {{familytree | | | |,|-|^|-|.| | | |,|-|^|-|.| | |}}
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| {{familytree | | | I01 | | I02 | | I03 | | I04 | | | I01=Yes|I02=No|I03=Yes|I04=No}}
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| {{familytree | | | |!| | | |!| | | |!| | | |!| | | |}}
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| {{familytree | | | J01 | | J02 | | J03 | | J04 | | | J01=Surgical resection + [[lymph node]] dissection|J02=[[Non small cell carcinoma of the lung radiation therapy#Stereotactic Ablative Radiotherapy Usual Dosage|stereotactic ablative radiation therapy]]|J03=Surgical resection + [[lymph node]] dissection|J04=Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodesand intrapulmonar nodes (N1)?}}
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| {{familytree | | | | | | | | | | | | | |,|-|^|-|.| | |}}
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| {{familytree | | | | | | | | | | | | | K01 | | K02 | | |K01=Yes|K02=No}}
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| {{familytree | | | | | | | | | | | | | |!| | | |!| | | |}}
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| {{familytree | | | | | | | | | | | | | L01 | | L02 | | | L01=[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|L02=[[Non small cell carcinoma of the lung radiation therapy#Stereotactic Ablative Radiotherapy Usual Dosage|stereotactic ablative radiation therapy]]<br>Adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]] should be added for high-risk stages}}
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| {{familytree/end}}
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| ==Stage II==
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| '''Stage IIA'''
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| * 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.
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| {{familytree/start}}
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| {{familytree | | | B01 | | | B01=<div style="float: left; text-align: left;">
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| * T1a-b, 2a, N1<br>
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| * T2b, N0<br>
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| * T3 Tumor larger than 7 cm (not invasive)</div>}}
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| {{familytree | | | |!| | | | | | | | |}}
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| {{familytree | | | C01 | | | | | C01=<div style="float: left; text-align: left;">'''Perform a pretreatment evaluation'''<br>
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| * If not done, perform [[pulmonary function tests]]<br>
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| * Perform [[bronchoscopy]] (if possible intraoperative)<br>
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| * Perform a pathological [[lymph node]] evaluation<br>
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| * If not done, order [[PET]] scan or [[CT scan]]
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| </div>}}
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| {{familytree | | | |!| | | |}}
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| {{familytree | | | D01 | | | |D01=Does the pathological evaluation showed positive disease in the [[mediastinal]] [[lymph nodes]]?}}
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| {{familytree | |,|-|^|-|.| | | |}}
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| {{familytree | E01 | | E02 | | | E01=Yes|E02=No}}
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| {{familytree | |!| | | |!| | | | |}}
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| {{familytree | F01 | | F02 | | | F01=[[Non small cell carcinoma of the lung medical therapy stage III|Click here for the stage III treatment]]|F02=Is the [[tumor]] operable?}}
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| {{familytree | | |,|-|-|^|-|-|.| | |}}
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| {{familytree | | G01 | | | | G02 | | G01=Yes|G02=No}}
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| {{familytree | | |!| | | | | |!| | | |}}
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| {{familytree | | H01 | | | | H02 | | | | H01=Surgical resection + [[lymph node]] dissection|H02=Does the patient presents metastasis to ipsilateral [[Tracheobroncuial lymph nodes|peribronchial]] and/or [[Tracheobroncuial lymph nodes|hiliar nodes]] and intrapulmonar nodes (N1)?}}
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| {{familytree | | |!| | | |,|-|^|-|.| | | |}}
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| {{familytree | | I03 | | I01 | | I02 | | | | | I01=Yes|I02=No|I03=If lymph node extension is detected initiate neoadjuvant[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]}}
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| {{familytree | | | | | | |!| | | |!| | |}}
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| {{familytree | | | | | | J01 | | J02 | | J01=[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus Radiation Therapy|chemotherapy + radiation therapy]]|J02=[[Non small cell carcinoma of the lung medical therapy radiation therapy|radiation therapy with stereotactic ablative radiotherapy]]<br>Adjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]] should be added for high-risk stages}}
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| {{familytree/end}}
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| <br>
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| '''Stage IIB'''
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| * 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.
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| {{familytree/start}}
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| {{familytree | | | | | | | C02 | | | | | | | | | | C02=<div style="float: left; text-align: left; width: 12em;">'''Perform a pretreatment evaluation'''<br>
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| * If not done, perform [[pulmonary function tests]]<br>
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| * Perform [[bronchoscopy]] (if possible intraoperative)<br>
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| * Perform a pathological [[lymph node]] evaluation<br>
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| * If not done, order [[PET]] scan or [[CT scan]]<br>
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| * Perform a [[Brain tumor MRI|brain MRI]]<br>
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| * Perform a spine [[MRI]] with thoracic inlet searching for superior suculus lesions and infiltration to the [[subclavian vessels]] or [[spine]]</div>}}
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| {{familytree | | | | | | | |!| | | | | | | | | | | | |}}
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| {{familytree | | | | | | | D02 | | | | | | | | | | D02=What is the location of the [[tumor]]?}}
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| {{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |}}
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| {{familytree | E03 | | | | | | | | | | | E04 | | | | E03=Superior suculus tumor|E04=<div style="float: left; text-align: left; width: 12em;">Proximal airway <br>OR<br> [[Chest wall]] <br>OR<br> [[Mediastinum]]</div>}}
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| {{familytree | |!| | | | | | |,|-|-|-|-|-|^|-|-|-|-|.| | | }}
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| {{familytree | F01 | | | | | F02 | | | | | | | | | F03 | | F01=T3 (Invasion to adjacent structures), N0|F02=<div style="float: left; text-align: left;">Preferred option: Surgery + pathological determination of microscopic residual [[tumor]]</div>|F03=<div style="float: left; text-align: left;">Neoadjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]] <br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]</div>}}
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| {{familytree | |!| | | | | | |!| | | | | | | | | | |!| | | |}}
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| {{familytree | G01 | | | | | G03 | | | | | | | | | G04 | | G01=Neoadjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]|G02=T4|G03=<div style="float: left; text-align: left;">Are margins from the surgical piece positive or negative for residual [[tumor]]?</div>|G04=<div style="float: left; text-align: left;">Perform surgery + pathological determination of residual tumor</div>}}
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| {{familytree | |!| | | |,|-|-|^|-|-|.| | | | | | | |!| | | | | | | | | |}}
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| {{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | | | | | | | | H01=Surgery + adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]|H03=Negative (R0)|H04=<div style="float: left; text-align: left;">Positive: Is the residual [[tumor]] microscopic (R1) or macroscopic (R2)</div>|H05=Are margins from the surgical piece positive or negative for residual [[tumor]]?}}
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| {{familytree | | | | | |!| | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | |}}
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| {{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | | | | I03=No|I04=Adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]|I05=Microscopic (R1)|I06=Macroscopic (R2)|I07=Negative (R0)|I08=Positive (R1-2)}}
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| {{familytree | | | | | | | | | |!| | | |!| | | |!| | | |!| | | | | |}}
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| {{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | | J01=Initiate neoadjuvant [[Non small cell carcinoma of the lung chemotherapy#Chemotherpay plus Radiation Therapy|Chemotherapy + radiation therapy]]|J02=Initiate definitive [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus Radiation Therapy|chemotherapy + radiation therapy]]|J03=[[Tumor]] resection + adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]<br>OR<br> [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]], followed or not by [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus Radiation Therapy, Followed by Chemotherapy|chemotherapy]]|J04=[[Tumor]] resection + adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]<br>OR<br> [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus Radiation Therapy|chemotherapy + radiation therapy]]|J05=Observation|J06=[[Tumor]] resection}}
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| {{familytree/end}}
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| ==Stage III==
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| * 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.
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| '''Stage IIIA: T3, N1'''
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| {{familytree/start}}
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| {{familytree | | | | | | | Z01 | | | | | | | | | Z01=<div style="float: left; text-align: left; width: 16em; padding:1em;">'''Perform a pretreatment evaluation'''<br>
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| * If not done, perform [[pulmonary function tests]]<br>
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| * Perform [[bronchoscopy]] (if possible intraoperative)<br>
| |
| * Perform a pathological [[lymph node]] evaluation<br>
| |
| * If not done, order [[PET]] scan or [[CT scan]]<br>
| |
| * Perform a [[Brain tumor MRI|brain MRI]]<br>
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| * Perform a spine [[MRI]] with thoracic inlet searching for superior suculus lesions and infiltration to the subclavian vessels or [[spine]]</div>}}
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| {{familytree | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | A01 | | | | | | | | A01=Where is the tumor located?}}
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| {{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | |}}
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| {{familytree | E03 | | | | | | | | | | | E04 | | | | | | E03=<div style="float: left; text-align: left;">Superior suculus tumor</div>|E04=<div style="float: left; text-align: left;">Proximal airway <br>OR<br> [[Chest wall]] <br>OR<br> [[Mediastinum]]</div>}}
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| {{familytree | |!| | | | | | |,|-|-|-|-|-|^|-|-|-|-|.| | |}}
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| {{familytree | F01 | | | | | F02 | | | | | | | | | F03 | | F01=<div style="float: left; text-align: left;">T3 (Invasion to adjacent structures), N0</div>|F02=<div style="float: left; text-align: left;">Preferred option: Surgery + pathological determination of microscopic residual [[tumor]]</div>|F03=<div style="float: left; text-align: left;">Neoadjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]] <br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]</div>}}
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| {{familytree | |!| | | | | | |!| | | | | | | | | | |!| | | |}}
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| {{familytree | G01 | | | | | G03 | | | | | | | | | G04 | | | G01=<div style="float: left; text-align: left;">Neoadjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]</div>|G02=T4|G03=<div style="float: left; text-align: left;">Are margins from the surgical piece positive or negative for residual [[tumor]]?</div>|G04=<div style="float: left; text-align: left;">Perform surgery + pathological determination of residual tumor</div>}}
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| {{familytree | |!| | | |,|-|-|^|-|-|.| | | | | | | |!| | | |}}
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| {{familytree | H01 | | H03 | | | | H04 | | | | | | H05 | | | H01=<div style="float: left; text-align: left;">Surgery + adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]</div>|H03=Negative (R0)|H04=<div style="float: left; text-align: left;">Positive: Is the residual [[tumor]] microscopic (R1) or macroscopic (R2)</div>|H05=Are margins from the surgical piece positive or negative for residual [[tumor]]?}}
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| {{familytree | | | | | |!| | | |,|-|^|-|.| | | |,|-|^|-|.| | |}}
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| {{familytree | | | | | I04 | | I05 | | I06 | | I07 | | I08 | | I03=No|I04=Adjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]]|I05=Microscopic (R1)|I06=Macroscopic (R2)|I07=Negative (R0)|I08=Positive (R1-2)}}
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| {{familytree | | | | | | | | | |!| | | |!| | | |!| | | |!| | |}}
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| {{familytree | | | | | | | | | J03 | | J04 | | J05 | | J06 | | J01=Initiate neoadjuvant [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|J02=Initiate definitive [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|J03=[[Tumor]] resection + adjuvant [[Non small cell carcinoma of the lung chemotherapy|chemotherapy]]<br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]], followed or not by [[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy, followed by chemotherapy|Chemotherapy]]|J04=[[Tumor]] resection + adjuvant [[Non small cell carcinoma of the lung chemotherapy|Chemotherapy]]<br>OR<br>[[Non small cell carcinoma of the lung chemotherapy#Chemotherapy plus radiation therapy|chemotherapy + radiation therapy]]|J05=Observation|J06=[[Tumor]] resection}}
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| {{familytree/end}}
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| <br>
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| ==References==
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| {{reflist|2}}
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| [[Category:Disease]]
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| [[Category:Types of cancer]]
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| [[Category:Pulmonology]]
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| [[Category:Lung cancer]]
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| [[Category:Oncology]]
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