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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Non small cell lung cancer management

Introduction

Overview

Overview

The optimal management approach of non-small cell lung cancer will depend on a series of characteristics, that include: pre-treatment evaluation, location, and adequate staging. Common treatment options for management of non-small cell lung cancer include surgery, neoadjuvant chemotherapy, adjuvant chemotherapy, and radiation therapy.

Management Approach

Management Approach

  • The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer.[1] To have a detailed information on the sequential management please click on each TNM stage in the table.
Standard Treatment Options
Adapted from Non-Small Cell Lung Cancer Treatment (PDQ® 2016) [1]
Stage (TNM criteria) Standard Treatment Options
Stages IA and IB
  • Surgery
  • Radiation therapy
  • IB, if the tumor is >4cm, surgery and chemotherapy
Stages IIA and IIB
  • Surgery
  • Neoadjuvant chemotherapy
  • Adjuvant chemotherapy
  • Radiation therapy
Stage IIIA

Resected or resectable disease

  • Surgery
  • Neoadjuvant therapy
  • Adjuvant therapy

Unresectable disease

  • Radiation therapy
  • Chemoradiation therapy

Superior sulcus tumors

  • Radiation therapy alone
  • Radiation therapy and surgery
  • Concurrent chemotherapy with radiation therapy and surgery
  • Surgery alone (for selected patients)

Tumors that invade the chest wall

  • Surgery
  • Surgery and radiation therapy
  • Radiation therapy alone
  • Chemotherapy combined with radiation therapy and/or surgery
Stage IIIB
  • Sequential or concurrent chemotherapy and radiation therapy
  • Chemotherapy followed by surgery (for selected patients)
  • Radiation therapy alone
Stage IV
  • Cytotoxic combination chemotherapy (first line)
  • Combination chemotherapy with bevacizumab or cetuximab
  • EGFR tyrosine kinase inhibitors (first line)
  • EML4-ALK inhibitors in patients with EML-ALK translocations
  • Immune checkpoint inhibition with nivolumab for selected patients with squamous or nonsquamous metastatic

Maintenance therapy following first-line chemotherapy

  • Endobronchial laser therapy and/or brachytherapy (for obstructing lesions)
  • External-beam radiation therapy (primarily for palliation of local symptomatic tumor growth)
Recurrent
  • Radiation therapy (for palliation)
  • Chemotherapy or kinase inhibitors alone EGFR inhibitors in patients with/without EGFR mutations
  • EML4-ALK inhibitors in patients with EML-ALK translocations
  • Surgical resection of isolated cerebral metastasis (for highly selected patients)
  • Laser therapy or interstitial radiation therapy (for endobronchial lesions)
  • Stereotactic radiation surgery (for highly selected patients)
References

References

  1. ↑ 1.0 1.1 PDQ Adult Treatment Editorial Board. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032637/ Accessed on February 22, 2016

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