Management of stage I and stage II non-small cell lung cancer
- Howard J West, MD
Howard J West, MD
- Medical Director
- Thoracic Oncology Program
- Swedish Cancer Institute (Seattle)
- Eric Vallières, MD, FRCSC
Eric Vallières, MD, FRCSC
- Section Editor — Lung Cancer
- Surgical Director of the Lung Cancer Program
- Swedish Cancer Institute
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
- Section Editors
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
The treatment for lung cancer depends upon tumor histology (small cell versus non-small cell), extent (stage) and patient specific factors (eg, age, pulmonary function, comorbidity). The major subtypes of non-small cell lung cancer (NSCLC) include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, in decreasing order of frequency of occurrence. (See "Pathology of lung malignancies".)
Patients with NSCLC who have disease limited to one lung and not involving the mediastinum or more distant sites have localized, stage I or stage II disease (table 1). Stage I plus stage II disease accounts for approximately 30 percent of patients with NSCLC . In this setting, surgical resection is the primary approach to treatment if there are no contraindications.
The approach to treatment of patients with stage I and stage II disease will be reviewed here. Overviews of other aspects of lung cancer are presented separately. (See "Overview of the risk factors, pathology, and clinical manifestations of lung cancer" and "Overview of the initial evaluation, treatment and prognosis of lung cancer".)
The tumor node metastasis (TNM) staging system is used for treatment planning and prognostic purposes in patients with non-small cell lung cancer (NSCLC). The eighth edition will replace earlier editions of the TNM staging system in the United States beginning January 1, 2018 (table 1 and table 2). However, outside of the United States, the Union for International Cancer Control (UICC) has implemented the eighth edition changes as of January 1, 2017. (See "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Tumor, node, metastasis (TNM) staging system for non-small cell lung cancer".)
Clinical staging is often unreliable, and patients thought to have stage I or II disease are restaged pathologically following surgery. Pathologic staging of the mediastinal lymph nodes is performed either prior to or at the time of resection. The issue of when to pathologically stage patients with stage I or II disease is discussed separately. (See "Management of stage III non-small cell lung cancer", section on 'Mediastinal evaluation'.)
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- GENERAL APPROACH TO TREATMENT
- SURGICAL CANDIDATES
- Preoperative evaluation
- Limited (sublobar) resection
- - Intraoperative brachytherapy
- Video-assisted thoracoscopic surgery
- Mediastinal lymph node dissection
- Positive resection margins
- Chest wall involvement
- Local recurrence after surgery
- NONSURGICAL CANDIDATES
- Stereotactic body radiation therapy
- Conventionally fractionated radiation therapy
- Other ablative techniques
- ADJUVANT THERAPY
- Molecularly targeted therapy
- Postoperative RT
- Tumor grade
- Molecular markers
- Hospital case volume
- POST-THERAPY SURVEILLANCE
- Efficacy of surveillance
- Management of isolated thoracic recurrence
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Mediastinal staging
- Surgical candidates
- Nonsurgical candidates
- Adjuvant therapy