Info

🌱 來自: NSCLC Treatment

Pathologic stage I to IIIA (N1) of NSCLC Treatment

• Surgery:
  • VATS/ robotic-assisted surgery standard where possible, lobectomy w/ mediastinal node dissection preferred. If +margins, reresection preferred over RT
• RT:
  • If medically inoperable: SBRT, standard RT (60 Gy), radiofrequency or cryoablation. Multidisciplinary discussion mandatory
• Adj. Chemo:
  • Not recommended for stage IA, consider for stage IB (med onc consult mandatory). ↑ OS for stage II-IIIA, CIS doublet for 4 cycles (LACE, JCO 2008;26:3552), most studies used CIS/vinorelbine (NEJM 2005;352:2589), CIS/peme, & CIS/docetaxel w/ similar efficacy & ↑ tolerability
• Adj. Targeted Rx:
  • EGFR TKIs have DFS benefit, OS benefit inconclusive; osimertinib x3y for EGFR Mt stage II-IIIA DFS benefit
• PORT:
  • Potential benefit if N2 nodes, +margins. Rad onc consultation recommended for N2
• Multiple 1° Lung CAs:
  • Different histologies or same histology w/o mediastinal LN involvement or extrathoracic mets—treat by stage as separate primaries (J Thorac Cardiovasc Surg 1975;70:606)