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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 NSCLC Surgery
    Stage 0 NSCLC Surgery
    Endobronchial therapies
    Stages IA and IB NSCLC Surgery
    Radiation therapy
    Stages IIA and IIB NSCLC Surgery
    Neoadjuvant chemotherapy
    Adjuvant chemotherapy
    Radiation therapy
    Stage IIIA NSCLC 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 NSCLC Sequential or concurrent chemotherapy and radiation therapy
    Chemotherapy followed by surgery (for selected patients)
    Radiation therapy alone
    Stage IV NSCLC 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
    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 NSCLC 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)

    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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