Treatment Options for Non-Small Cell Lung Cancer by Stage

The treatment options for non-small cell lung cancer depend in part on where the lung cancer is located within the lungs and whether the cancer has spread or not. Here are options by stage of primary lung cancer, and by lung cancer that has recurred.

Stage I

  • Surgery, alone or followed by:
    • Radiation therapy
    • Chemotherapy, if high risk for recurrenceLung cancer that has come back after a period of time during which the cancer could not be detected
  • External beam radiation therapy (EBRT)A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body (for patients who cannot or choose not to have surgery), which may be followed by chemotherapy if high risk for recurrence
  • New treatments available through clinical trials:
    • Chemotherapy or radiation therapy following surgery
    • Surgery followed by chemopreventionThe use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer
    • Treatment given through an endoscopeA thin, tube-like instrument used to look at tissues inside the body, such as photodynamic therapy (PDT)Treatment with drugs that become active when exposed to light

Stage II

  • Surgery
  • Surgery, followed by chemotherapy with or without radiation therapy
  • Surgery, followed by radiation therapy
  • Chemotherapy, followed by surgery
  • External beam radiation therapy (EBRT) (for patients who cannot or choose not to have surgery)
  • New treatments available through clinical trials:
    • Surgery followed by radiation therapy
    • Immunotherapy
    • Other treatment options

Stage IIIA

If the patient has lung cancer that is resectableAble to be removed by surgery, the following may be treatment options:

  • Surgery followed by chemotherapy and postoperative radiation therapy (PORT)
  • Chemotherapy followed by surgery and PORT
  • New treatments available through clinical trials, including new types or combinations of treatments

If the patient has lung cancer that cannot be removed with surgery, options include:

  • Chemotherapy and radiation therapy given as separate treatments over the same period of time
  • External radiation therapy alone (for patients who cannot be treated with combined therapy, as palliative treatment to relieve symptoms and improve the quality of life)
  • Internal radiation therapyA type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor; also called "brachytherapy" or laser surgery, as palliative treatment to relieve symptoms and improve the quality of life
  • New treatments available through clinical trials, including new types or combinations of treatments

Supportive care (also called palliative careCare given to improve the quality of life of patients who have a serious or life-threatening disease) is also helpful for signs and symptoms including cough, shortness of breath, and chest pain. Read more about palliative care.

Non-small cell lung cancer of the superior sulcus, often called a Pancoast tumorA type of lung cancer that begins in the upper part of a lung and spreads to nearby tissues such as the ribs and vertebrae, begins in the upper part of the lung and spreads to nearby tissues such as the ribs and vertebrae. Treatment of Pancoast tumors may include the following:

  • Radiation therapy alone
  • Radiation therapy followed by surgery
  • Chemotherapy and radiation therapy given as separate treatments over the same period of time, followed by surgery
  • Surgery alone
  • A clinical trial of new combinations of treatments

Stage IIIB

  • External beam radiation therapy
  • Chemotherapy and external beam radiation therapy given one after the other or combined at the same time
  • Targeted therapy with a tyrosine kinase inhibitorA type of targeted therapy that blocks the action of enzymes called tyrosine kinases in order to keep cancer cells from growing
  • Internal radiation therapy as palliative care
  • Immunotherapy drugs
  • New treatments available through clinical trials

Supportive (palliative) care is also helpful for signs and symptoms including cough, shortness of breath and chest pain. Read more about palliative care.

Stage IV

  • Combination chemotherapy
  • Combination chemotherapy, followed by maintenance therapyTreatment that is given to help keep cancer from coming back after it has disappeared following the initial therapy with an anticancer drug to help keep the cancer from progressing
  • Combination chemotherapy and targeted therapy with a monoclonal antibodyA type of protein made in the laboratory that can bind to substances in the body, including cancer cells
  • Targeted therapyA type of treatment that uses drugs to identify and attack specific types of cancer cells with less harm to normal cells
  • External or internal radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life
  • Laser therapy and/or internal radiation therapy
  • Immunotherapy drugs
  • Combination immunotherapy and chemotherapy
  • Clinical trials of chemotherapy drugs, targeted drug therapy, immunotherapy drugs, or a combination of these

Recurrent NSCLC

  • Chemotherapy
  • Targeted therapy
  • Laser therapy or internal radiation therapy
  • Surgery to remove a very small amount of cancer that has spread to the brain
  • External beam radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life
  • Stereotactic radiosurgeryA type of stereotactic body radiation therapy that is given in a single large dose of radiation to a tumor1,2

Updated May 19, 2017.


References

  1. Lung Cancer – Non-Small Cell: Treatment Options. American Society of Clinical Oncology website. http://www.cancer.net/cancer-types/lung-cancer-non-small-cell/treatment-options. Approved August 2015. Accessed March 4, 2016.
  2. Non-Small Cell Lung Cancer Treatment (PDQ®): Treatment Options by Stage. National Cancer Institute website. http://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq#link/_205. Updated May 12, 2015. Accessed March 4, 2016.

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