Stage
Operative intervention
Radiation
Chemotherapy
Stage I
Surgical resection for cure
Primary radiotherapy in patients not fit for operation with intent to cure
Stage II
Surgical resection for cure
Radiation with intent to cure in patients with inoperable disease
Cisplatin-based adjuvant improves survival
Stage II
Surgical resection for cure
Radiation with intent to cure in patients with inoperable disease
Cisplatin-based adjuvant improves survival
Stage IIIA (incidental, potentially resectable, unresectable)
Thoracotomy and potential resection
Adjuvant radiation unclear outcomes
Adjuvant chemotherapy
Stage IIIB
Not surgical candidates
Radiation appropriate
Primary treatment or palliation
Stage IV
Not surgical candidate
Not radiotherapy candidate
Survival improvement with supportive care
The seventh edition of the TNM staging system (Table 3.2) is the most recent version. It was developed by the International Association for the Study of Lung Cancer and approved by the American Joint Committee on Cancer and the International Union Against Cancer.
Table 3.2
TNM staging of NSCLC
T/M | Subgroup | N0 | N1 | N2 | N3 |
|---|---|---|---|---|---|
T1 | T1a | Ia | IIa | IIIa | IIIb |
T1b | Ia | IIa | IIIa | IIIb | |
T2 | T2a | Ib | IIa | IIIa | IIIb |
T2b | IIa | IIb | IIIa | IIIb | |
T3 | T3>7 | IIb | IIIa | IIIa | IIIb |
T3Inv | IIb | IIIa | IIIa | IIIb | |
T3Satell | IIb | IIIa | IIIa | IIIb | |
T4 | T4Inv | IIIa | IIIa | IIIb | IIIb |
T4Ipsi Nod | IIIa | IIIa | IIIb | IIIb | |
M1 | M1aContra Nod | IV | IV | IV | IV |
M1aPl Disem | IV | IV | IV | IV | |
M1b | IV | IV | IV
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