Comprehensive treatment of lung cancer Multidisciplinary comprehensive treatment of non-small cell lung cancer (I) Stage I (T1-2N0M0) Stage I includes: Stage IA T1N0M0 and Stage IB T2N0M0. ① Preferred surgical treatment. The 5-year survival rate after surgery is 63%, including 71% for stage IA, 68% for squamous carcinoma and 61% for adenocarcinoma. The median survival is 22 months, the 2-year survival rate is 22%, the 5-year survival rate is 16%, and the local recurrence rate is about 70%. 70% of patients die of lung cancer. (iii) Stage I lung cancer with complete resection does not require adjuvant radiotherapy or chemotherapy. Adjuvant biologic therapy can be considered to help improve survival: the 5-year tumor-free survival rate is 71.6% (62.0% in the control group) (400 cases reported by Japanese scholars). ④ Incompletely resected stage I lung cancer with positive surgical margins is recommended for reoperation. If surgery is not possible or desired, postoperative radiotherapy + chemotherapy can help improve survival (30% 5-year survival rate for those with positive microscopy and no 5-year survival rate for those with positive meatus). (ii) Stage II lung cancer Stage II includes: IIA (T1N1M0), IIB (T2N1M0, T3N0M0). ① Preferred surgical treatment. The 5-year survival rate after surgery is 41%, including 52% in stage IIA and 39% in stage IIB; 47% in squamous carcinoma and 29% in adenocarcinoma. ②Stage II lung cancer with complete resection of N1 or invasion of the chest wall does not require adjuvant radiotherapy, and postoperative radiotherapy is not beneficial but harmful to long-term survival. Adjuvant chemotherapy containing platinum may prolong the survival rate. ③Incomplete resection of stage II lung cancer with positive surgical margins is recommended for reoperation to make it complete, otherwise radiotherapy should be given. ④Advocate preoperative neoadjuvant radiotherapy and chemotherapy: simultaneous radiotherapy and chemotherapy (2-3 weeks of chemotherapy and half amount of radiotherapy) followed by surgical resection. If unresectable, continue radiotherapy and chemotherapy. (iii) Stage III Stage III is also called locally advanced stage. It includes stage IIIA (T3N1M0, T1-3N2M0) and stage IIIB (any TN3M0, T4N0-2M 0). The 5-year survival rate in stage IIIA: (5-23%) and only 6-7% in stage IIIB. Untreated stage III median survival 7-9 months Incidental stage IIIA: preoperative staging of stages I and II, but postoperative pathology only reveals mediastinal lymph node metastases. Marginal stage IIIA: Imaging of a mediastinal mass with enlarged mediastinal lymph nodes. (1) Resectable stage N2III, neoadjuvant chemotherapy + surgical resection is recommended. However, the 5-year survival rate increased again from 16% to 28% for surgery alone. ②After complete resection 4 cycles of adjuvant chemotherapy with third-generation platinum-containing regimens are recommended postoperatively. (3-4 cycles of chemotherapy compared with more than 6 cycles of chemotherapy showed comparable survival rates, but with significantly less toxic side effects). And the role of adjuvant radiotherapy remains unclear. ③For stage III NSCLC after incomplete resection, postoperative radiotherapy and chemotherapy with platinum-containing regimens are recommended. ④Resectable patients who cannot undergo surgery due to medical reasons or patient’s wishes are treated as unresectable patients. ⑤ Treatment of unresectable stage III NSCLC: A. The standard treatment modality is a combination of chemotherapy + radiotherapy with platinum-containing regimens. The MVP regimen + radiotherapy (56Gy) study showed that the former had a median survival of 17 months and a 5-year survival rate of 16%; the latter had a median survival of 13 months and a 5-year survival rate of 9%. B. If down-staging occurs with 2-3 cycles of induction chemotherapy and the lesion transforms into technically resectable NSCLC, surgical treatment is recommended. It may improve the median survival and 5-year survival rate. C. For those with PS=2, in principle, combined chemoradiotherapy is also preferable, but for elderly patients with low tolerance, it is recommended but doing radiotherapy or chemotherapy has reduced symptoms and prolonged survival. And those with PS>2, the best supportive therapy is the main means. (6) Stage IIIB treatment for T4, N0-1 A. Neoadjuvant chemotherapy + surgical resection or surgical resection is preferred for those who can be resected. In case of complete resection, postoperative adjuvant chemotherapy may not be considered; in case of incomplete resection or positive surgical margins, postoperative chemotherapy and radiotherapy are recommended. B. For unresectable patients, the current standard treatment mode is a combination of chemotherapy + radiotherapy with platinum-containing regimen. C. For T4IIIB stage of pleural effusion, if multiple pleural fluid tests are negative, treatment will be according to TNM stage; if positive, treatment will be according to stage IV, with local treatment of the chest cavity if necessary. (iv) Stage IV All those with distant metastases are considered stage IV (M1). The median survival of untreated stage IV NSCLC is 4-5 months. (i) Stage IV with a single metastasis: A. For NSCLC with a single brain metastasis and a resectable lung lesion, the brain lesion can be surgically resected or treated with stereotactic radiotherapy. The primary lesion in the chest is treated according to TNM staging principles. The overall median survival was 11 months, with a 5-year survival rate of 14%. If all brain and lung lesions are completely resected, the median survival is 20 months and the 5-year survival rate is 21%. Isolated brain metastases smaller than 3 cm can achieve similar survival rates to surgery using stereotactic radiotherapy. Postoperative whole brain irradiation for brain metastases reduces the intracranial recurrence rate but does not improve survival. B. Isolated nodules in the contralateral lung or other lobes of the ipsilateral lung can be treated according to the respective TNM stages of the two primary tumors. ② Stage IV with multiple metastases: A. Systemic chemotherapy should be started as early as possible for PS=0-2 B. For PS>2, best supportive therapy may be used as appropriate (V) Alternative third-generation platinum-containing chemotherapy regimens