Table 1.
Therapeutic strategies in non-small cell lung carcinoma (NSCLC) based upon the stages of lung cancer adapted from the 8th Edition of TNM [3,18].
| Eight Edition TNM Staging System | Treatment Options | |||
|---|---|---|---|---|
| Stage IA1 | T1a | N0 | M0 | surgery alone |
| Stage IA2 | T1b | N0 | M0 | |
| Stage IA3 | T1c | N0 | M0 | |
| Stage IB | T2a | N0 | M0 | <4 cm surgery alone |
| >4 cm surgery followed by adjuvant chemotherapy | ||||
| Stage IIA | T2b | N0 | M0 | Surgery followed by adjuvant chemotherapy |
| There is no role of postoperative radiation therapy in patients following resection of stage I or II NSCLC with negative margins | ||||
| Stage IIB | T1a-T2b | N1 | M0 | Patients with stage I and II disease who refuse or are not suitable candidates for surgery should be considered for radiation therapy with curative intent |
| T3 | N0 | M0 | ||
| Stage IIIA | T1-2b | N2 | M0 | N0 or N1 nodes—Surgery followed by adjuvant chemotherapy |
| T3 | N1 | M0 | N2 or N3 nodes—No surgery, treatment with combined chemoradiation therapy | |
| T4 | N0/N1 | M0 | The optimal treatment strategy has not been clearly defined; despite many potential treatment options, none yields a very high probability of cure; stage III is highly heterogeneous, and no single treatment approach can be recommended for all patients | |
| Stage IIIB | T1-2b | N3 | M0 | |
| T3/T4 | N0/N1 | M0 | ||
| T3/T4 | N3 | M0 | ||
| Stage IVA | Any T | Any N | M1a/M1b | Use of pain medications and the appropriate use of radiotherapy and systemic therapy, which may compromise of traditional cytotoxic chemotherapy, targeted therapy, and immunotherapy depending on the specific diagnosis and molecular subtype |
| Stage IVB | Any T | Any N | M1c | |
TNM—TNM Classification of Malignant Tumors (tumor-lymph nodes-metastasis); T1—≤3 cm surrounded by lung/visceral pleura, not involving main bronchus; T1a—primary tumor ≤ 1 cm; T1b—>1 to ≤2 cm; T1c—>2 to ≤3 cm; T2—>3 to ≤5 cm or involvement of main bronchus without carina, regardless of distance from carina or invasion visceral pleural or atelectasis or post-obstructive pneumonitis extending to hilum; T2a—>3 to ≤4 cm; T2b—>4 to ≤5 cm; T3—>5 to ≤7 cm in greatest dimension or tumor of any size that involves chest wall, pericardium, phrenic nerve or satellite nodules in the same lobe; T4—>7 cm in greatest dimension or any tumor with invasion of mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carina, trachea, esophagus, spine or separate tumor in different lobe of ipsilateral lung; N0—no lymph nodes metastasis; N1—ipsilateral peribronchial and/or hilar nodes and intrapulmonary nodes; N2—ipsilateral mediastinal and/or subcarinal nodes; N3—contralateral mediastinal or hilar; ipsilateral/contralateral scalene/supraclavicular; M0—no distant metastasis; M1—distant metastasis; M1a—tumor in contralateral lung or pleural/pericardial nodule/malignant effusion; M1b—single extrathoracic metastasis, including single non-regional lymph node; M1c—multiple extrathoracic metastases in one or more organs.