Treatment Of Stage I And II Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Publication Date: November 1, 2013
Last Updated: March 14, 2022
Recommendations
General Approach to Stage I and II NSCLC
For patients with clinical stage I and II NSCLC and no medical contraindications to operative intervention, surgical resection is recommended. (1, B)
307795
For patients with clinical stage I and II NSCLC, it is suggested that they be evaluated by a thoracic surgical oncologist or a multidisciplinary team even if the patients are considered for nonsurgical therapies such as percutaneous ablation or stereotactic body radiation therapy. (2, C)
307795
For patients with clinical stage I or II NSCLC and who are medically fit, it is recommended that they be treated by a board certified thoracic surgeon with a focus on lung cancer. (1, B)
307795
Lobectomy—Surgical Issues
For patients with clinical stage I NSCLC, a minimally invasive approach such as videoassisted thoracic surgery (thoracoscopy) is preferred over a thoracotomy for anatomic pulmonary resection and is suggested in experienced centers. (2, C)
307795
For patients with clinical stage I and II NSCLC, systematic mediastinal lymph node sampling or dissection at the time of anatomic resection is recommended for accurate pathologic staging. (1, B)
307795
For patients with clinical stage I NSCLC undergoing anatomic resection who have undergone systematic hilar and mediastinal lymph node staging showing intraoperative N0 status, the addition of a mediastinal lymph node dissection does not provide a survival benefit and is not suggested. (2, A)
307795
For patients with clinical stage II NSCLC undergoing anatomic resection, mediastinal lymph node dissection may provide additional survival benefit over mediastinal lymph node sampling and is suggested. (2, B)
307795
For patients with clinical stage I or II central NSCLC in whom a complete resection can be achieved, a sleeve or bronchoplastic resection is suggested over a pneumonectomy. (2, C)
307795
Sublobar Resection
For patients with clinical stage I and II NSCLC, who are medically fit for surgical resection a lobectomy rather than sublobar resection is recommended. (1, B)
307795
For patients with clinical stage I NSCLC who may tolerate operative intervention but not a lobar resection due to decreased pulmonary function or comorbid disease, sublobar resection is recommended over nonsurgical therapy. (1, B)
307795
During sublobar resection of solid tumors in compromised patients, it is recommended that margins greater than the maximal tumor diameter for lesions less than 2 cm should be achieved. For tumors larger than 2 cm at least 2 cm gross margins should be sought to minimize the likelihood of a positive margin and/or local recurrence. (1, C)
307795
In patients with major increased risk of perioperative mortality or competing causes of death (due to age related or other co-morbidities), an anatomic sublobar resection (segmentectomy) over a lobectomy is suggested. (2, C)
307795
For patients with a clinical stage I predominantly GGO lesion 2 cm, a sublobar resection with negative margins is suggested over lobectomy. (2, C)
307795
Nonsurgical Treatment Approaches to Stage I NSCLC
For patients with clinical stage I NSCLC who cannot tolerate a lobectomy or segmentectomy, SBRT and surgical wedge resection are suggested over no therapy. (2, C)
307795
Postoperative (Adjuvant) Therapy
For patients with completely resected pathologic stage IA,B NSCLC, it is recommended that postoperative chemotherapy not be used (outside of a clinical trial). (1, B)
307795
For patients with completely resected pathologic stage II(N1) NSCLC and good performance status, postoperative platinum-based chemotherapy is recommended. (1, A)
307795
For patients with completely resected pathologic stage I NSCLC, it is recommended that postoperative radiation therapy should not be used. (1, A)
307795
For patients with completely resected pathologic stage II NSCLC, it is suggested that postoperative radiation therapy should not be used. (2, A)
307795
For patients with stage I and II NSCLC and a positive bronchial margin (R1 resection), postoperative radiation therapy is suggested. (2, C)
307795
Title
Treatment Of Stage I And II Non-Small Cell Lung Cancer: Diagnosis And Management Of Lung Cancer
Authoring Organization
American College of Chest Physicians
Publication Month/Year
November 1, 2013
Last Updated Month/Year
June 26, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
The treatment of stage I and II non-small cell lung cancer (NSCLC) in patients with good or low surgical risk is primarily surgical resection. However, this area is undergoing many changes. With a greater prevalence of CT imaging, many lung cancers are being found that are small or constitute primarily ground-glass opacities. Treatment such as sublobar resection and nonsurgical approaches such as stereotactic body radiotherapy (SBRT) are being explored. With the advent of minimally invasive resections, the criteria to classify a patient as too ill to undergo an anatomic lung resection are being redefined.
Target Patient Population
Patients with stage I / II non-small cell lung cancer (NSCLC)
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Long term care, Outpatient, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D002289 - Carcinoma, Non-Small-Cell Lung, D013903 - Thoracic Surgery, D008175 - Lung Neoplasms, D011878 - Radiotherapy, D018714 - Radiotherapy, Adjuvant
Keywords
lung cancer, non-small cell lung cancer, CT imaging, radiotherapy, Non Small Cell Lung Cancer, non_small_cell_lung_cancer, early stage cancer