What are the ACCP recommendations for treatment of clinical stage I and II non–small cell lung cancer (NSCLC)?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

The updated ACCP guidelines recommendations for treatment of clinical stage I and II NSCLC include [81] :

  • Surgical resection is the primary and preferred treatment approach for patients with no medical contraindications and a lobectomy rather than sub-lobar resection is preferred; however, in patients with major increased risk of perioperative mortality or competing causes of death (due to age-related or other co-morbidities), an anatomic sub-lobar resection (segmentectomy) over a lobectomy is suggested

  • Patients should be evaluated by a thoracic surgical oncologist even if they are considered for nonsurgical therapies such as percutaneous ablation or stereotactic body radiation therapy

  • For clinical stage I patients, a minimally invasive approach such as video-assisted thoracoscopy surgery (VATS) is preferred over a thoracotomy for anatomic pulmonary resection

  • For patients with in whom a complete resection can be achieved, a sleeve or bronchoplastic resection is suggested over a pneumonectomy

  • For patients with clinical stage I NSCLC who cannot tolerate a lobectomy or segmentectomy, stereotactic body radiation therapy (SBRT) and surgical wedge resection are suggested over no therapy

  • The use of adjuvant chemotherapy for stage II NSCLC is recommended and has shown benefit

  • The use of adjuvant radiation or chemotherapy for stage I NSCLC is of unproven benefit


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