T2 N1 M0 = Estadio IIB
Non–Small Cell Lung Cancer - Stage I and II Disease:
For stage I and II NSCLC, surgery is the initial treatment of choice. Before surgical resection, a comprehensive preoperative medical evaluation is mandatory ( Chapter 457 ). This evaluation must be supplemented by pulmonary function tests (forced expiratory volume at 1 second [FEV1] and diffusing capacity of the lung for carbon monoxide [Dlco]), as well as blood gas analysis ( Chapter 85 ). FEV1 and Dlco will determine what surgical procedure can be performed safely—pneumonectomy, lobectomy, wedge resection, or segmentectomy. A preoperative FEV1 less than 40% of predicted and a Dlco less than 40% of normal are associated with an increase in operative mortality. Threshold levels to define resectability include a preoperative FEV1 greater than 2.0 L and Dlco greater than 60% for pneumonectomy and a preoperative FEV1 greater than 1.5 L and Dlco greater than 50% for lobectomy. Other factors for determining resectability include exercise tolerance and comorbid disease. The curability of the patient is dependent on the stage of disease and completeness of the resection and not whether lobectomy or pneumonectomy is performed. By comparison, there is a significant risk of local recurrence in patients undergoing wedge resection or segmentectomy rather than more extensive resection of the tumor. Mortality rates for lobectomy and pneumonectomy are 3% and 9%, respectively. For patients older than 70 years, the mortality for pneumonectomy rises to 16 to 25%.
At surgery, a tumor is considered to be unresectable if a metastasis is found in the pleura or contralateral mediastinal lymph nodes or if there is tumor invasion of the mediastinum, heart, great vessels, or other structures. In addition to surgical resection of the tumor, sampling or complete removal of all accessible mediastinal lymph nodes should be performed.
Adjuvant cisplatin-based chemotherapy (e.g., cisplatin, 80 mg/m2 every 3 weeks for four doses or 100 mg/m2 every 4 weeks for three or four doses, or cisplatin, 120 mg/m2 every 4 weeks for three doses, plus etoposide, 100 mg/m2 for 3 days/cycle, vinorelbine, 30 mg/m2 weekly, vinblastine, 4 mg/m2 weekly, or vindesine, 3 mg/m2 weekly) provides a small absolute increase in overall survival at 5 years for stage I, II, and III disease. [1] [2] Treatment with monoclonal antibodies has not yet been consistently beneficial. [3] [4] [5]
Adjuvant radiation therapy for stage I and II disease is not indicated. However, in patients with stage I NSCLC who for medical reasons are not candidates for surgery, radiation therapy (usually a total dose of 65 to 70 Gy in 2-Gy fractions) can be given with curative intent. Five-year survival rates in patients thus treated range from 10 to 30%.
Fuente: Cecil 23 ed
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