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Lung Cancer Health Center

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Non-Small Cell Lung Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview for NSCLC

Table 11. Standard Treatment Options for NSCLC

Stage (TNM Staging Criteria)Standard Treatment Options
Occult NSCLCSurgery
Stage 0 NSCLCSurgery
Endobronchial therapies
Stages IA and IB NSCLCSurgery
Radiation therapy
Stages IIA and IIB NSCLCSurgery
Neoadjuvant chemotherapy
Adjuvant chemotherapy
Radiation therapy
Stage IIIA NSCLCResected or resectable diseaseSurgery
Neoadjuvant therapy
Adjuvant therapy
Unresectable diseaseRadiation therapy
Chemoradiation therapy
Superior sulcus tumorsRadiation therapy alone
Radiation therapy and surgery
Concurrent chemotherapy with radiation therapy and surgery
Surgery alone (for selected patients)
Tumors that invade the chest wallSurgery
Surgery and radiation therapy
Radiation therapy alone
Chemotherapy combined with radiation therapy and/or surgery
Stage IIIB NSCLCSequential or concurrent chemotherapy and radiation therapy
Chemotherapy followed by surgery (for selected patients)
Radiation therapy alone
Stage IV NSCLCCytotoxic 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
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 NSCLCRadiation 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)

In addition to the standard treatment options presented in Table 11, treatment options under clinical evaluation include the following:

  • Combining local treatment (surgery).
  • Regional treatment (radiation therapy).
  • Systemic treatments (chemotherapy, immunotherapy, and targeted agents).
  • Developing more effective systemic therapy.


Several small series have reported that reduction in fluorodeoxyglucose-positron emission tomography (FDG-PET) after chemotherapy, radiation therapy, or chemoradiation therapy correlates with pathological complete response and favorable prognosis.[8,9,10,11,12,13,14,15] Studies have used different timing of assessments, FDG-PET parameters, and cutpoints to define FDG-PET response. Reduction in maximum standardized uptake value (SUV) of more than 80% predicted for complete pathological response with a sensitivity of 90%, specificity of 100%, and accuracy of 96%.[16] Median survival after resection was greater for patients with tumor SUV values of less than 4 (56 mo vs. 19 mo).[15] Patients with complete metabolic response following radiation therapy were reported to have median survivals of 31 months versus 11 months.[17]

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