Non-Small Cell Lung Cancer - Treatment Options by Stages

Stage II

In stage II the cancer cells have spread to nearby lymph nodes.

General Treatment Options. Surgery, usually removal of a lobe (lobectomy) or one lung (pneumonectomy) is the treatment of choice. Five-year survival rates associated with stage II surgery can vary. A 2000 literature review places the numbers as high as 40% to 50%, but notes that they can drop to 25% and below if it has spread beyond the immediate lymph nodes. Patients whose cancer is inoperable may consider radiation treatments. In appropriate candidates who can complete treatment, five-year survival rates average 20% to 30%, with higher rates for IIA. Clinical trials should be considered for prevention of recurring cancer after primary treatment. To date, however, supplementing surgical treatment with radiation or chemotherapy does not appear to prolong survival rates.

Stage IIA (T1, N1, M0). Survival rates can be as high as 60%. 1. Surgery. 2. Radiation with intent to cure in selected patients. 3. Clinical trials of postoperative (adjuvant) chemotherapy. 4. Clinical trials of chemotherapy before, after, or during radiation treatments. 5. Clinical trials of chemotherapy (induction therapy) to reduce tumor size before surgery.
Stage IIB (T2, N1, M0) or (T3, N0, M0). Survival rates can be over 40%. 1. Surgery. 2. Radiation with intent to cure in selected patients. 3. Clinical trials of postoperative (adjuvant) chemotherapy. 4. Clinical trials of chemotherapy before surgery (induction therapy) 5. Clinical trials of chemotherapy before, after, or concurrent with radiation treatments.

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Stage III

In stage III, the cancer cells have spread beyond the lung to the chest wall, diaphragm, or further lymph nodes, such as those in the neck.

General Treatment Options. Generally, stage III tumors are treated with radiation and sometimes with surgery, chemotherapy, or combinations of each. Combination approaches may be significantly more effective than single treatments. For example, of particular interest is a treatment approach that uses initial concurrent chemotherapy and radiation followed by surgery. In one study five-year survival in stage III patients was nearly 50%.

Stage IIIA (T1, N2, M0) or (T2, N2, M0) or (T3, N1, M0) or (T3, N2, M0). 1. Surgery is considered if tumor and affected lymph nodes can be completely removed. Consider adjuvant platinum-based chemotherapy or radiation therapy afterward. 2. Concurrent radiation treatment plus platinum-based chemotherapy for those in otherwise good health followed by surgery, if possible. 3. Clinical trials using advanced radiation techniques, including continuous hyperfractionated accelerated or 3-D conformal radiation 4. Other clinical trials of various multimodal therapies, preventive radiation therapy to the brain, other second-line agents, and many other approaches and investigational agents.
Stage IIIB (Any T, N3, M0) or (T4, Any N, M0). Some patients may consider surgery if there is no lymph node involvement (T4, N0) and tumor can be removed. Other IIIB patients cannot be treated surgically. 1. Radiation alone, usually for symptom control. It may improve survival in certain patients, such as those with node involvement above the clavicle. 2. Chemotherapy alone. 3. Concurrent cisplatin-based chemotherapies plus radiation, sometimes followed by surgery if possible. 4. Clinical trials using induction chemotherapy alone to reduce tumors, which may then be treated with surgery or radiation. 5. Clinical trials using advanced radiation techniques, including continuous hyperfractionated accelerated or 3-D conformal radiation. 6. Other clinical trials of various multimodal therapies, preventive radiation therapy to the brain, other second-line agents, and many other approaches and investigational agents.