Lung cancer Flashcards
molecular markers for lung adenocarcinoma
TTF-1 +, cytokeritin 7/20+
molecular markers for squamous cell of lung
p63 and p40+
Stage I lung cancer simple definition
Treatment
mass <5 cm
lymph nodes negative
treat with resection or definitive SBRT
Stage II lung cancer simple
Mass with peribronchial or hilar node positive
OR mass with chest wall involved (with neg nodes)
OR multiple nodules within the same lobe (with neg nodes)
resection with lobectomy
Treat with surgery followed by adjuvant chemotherapy or adjuvant osimertinib
Stage III lung cancer simple
Mass with mediastinal involvement either invasion or mediastinal nodes
OR >7 cm N1
OR chest wall or mediastinal invasion N1
OR multiple nodules in the same lobe N1
IIIA- surgery then adjuvant chemotherapy or chemo/RT then surgery
IIIB or nonsugical IIIA- chemo/rads and durvalumab
Surgical evaluation for lung cancer
Stage I, II and select IIIA
adequate pulmonary reserve (pre-op PFTs)
low numbers (2, 4, 7, 8, 9)
mediastinal nodes N2
Double digit nodes
10-14 hilar, interlobar, lobar, segmental, subsegmental, resectable N1 nodes
adjuvant chemotherapy absolute benefit
modest advantage in stage II and III
squamous adjuvant therapy
cisplatin 75 mg/m2, gem 1250 mg/m2 or cis/docetaxel 75 mg/m2
Q3 weeks
4 cycles
Atezolizumab 1 year PD-L1 >1%
adenocarcinoma adjuvant therapy
cisplatin 75 mg/m2 /pemetrexed 500 mg/m2
Q3 weeks
4 cycles
Atezolizumab 1 year PD-L1 >1%
multiple nodules in the same lobe N1
Surgery up front and then adjuvant chemo
pancoast superior sulcus tumors n0-1
Chemo/rads then surgery or if unresectable durvalumab
Chest wall invasion or resectable T4 N0-N1
surgery first then adjuvant chemo +/- RT
or upfront Chemo/rads then surgery
Chemorad regimen for adenocarcinoma
cisplatin/pemetrexed
Q3 weeks for 4 cycles
Add durvalumab for 1 year (PACIFIC trial, PDL1 status does not matter)
