Comprehensive thoracic solid tumor staging and treatment options

Authored by Andrea Billè, published on 2026-04-13 18:54:38.0

Lung cancer management based on TNM staging, where early-stage (I–II) disease is primarily treated with surgical resection (with possible adjuvant therapy), while more advanced stages (III–IV) incorporate multimodal approaches including chemotherapy, radiation, and immunotherapy guided by resectability and molecular/PD-L1 status. Treatment decisions progressively shift from surgery-focused to systemic and combined therapies as stage and nodal/metastatic involvement increase.

  1. T characteristics
    Size Chest wall invasion (yes vs no) Satellite nodule (same lobe vs different lobe) Other structure invasion
    • T
      1a, 1b, 1c, 2a, 2b, 3, 4
      • STAGE
        Put in data to generate the stage
        • STAGE I
          • FIT
            • SURGERY
              • Algorithm for surgery - Coming soon
              • VATS/RATS
                • Lung resection
                  Wedge / Segment / Lobectomy
                  • Adjuvant treatment if upstaged
        • STAGE IIA/IIB
          • PDL1 status / Molecular profile
            • Resectable
              Thoracic solid tumour resectability in the ERA of Immunotherapy
              • Chemo IO
                No mutations
                • Surgery
              • Surgery
                EGFR pos / ALK pos
                • Chemo IO
                • Chemo + Osimertinib
                  EGFR pos
        • STAGE IIIA/IIIB
          • PDL1 status / Molecular profile
            • Resectable
              Thoracic solid tumour resectability in the ERA of Immunotherapy
              • Chemo IO
                No mutations
                • Surgery
              • Surgery
                EGFR pos / ALK pos
                • Chemo IO
                • Chemo + Osimertinib
                  EGFR pos
          • Unresectable?
            • Chemo/RT
              IO
              • Salvage surgery
        • STAGE IIIB (N3) / STAGE IIIC / STAGE IVA/B
          • ChemoTHerapy +/- Immunotherapy
            • ? RT
  2. N
    0, 1, 2a, 2b, 3 Specify the station
    • STAGE
      Put in data to generate the stage
      • STAGE I
        • FIT
          • SURGERY
            • Algorithm for surgery - Coming soon
            • VATS/RATS
              • Lung resection
                Wedge / Segment / Lobectomy
                • Adjuvant treatment if upstaged
      • STAGE IIA/IIB
        • PDL1 status / Molecular profile
          • Resectable
            Thoracic solid tumour resectability in the ERA of Immunotherapy
            • Chemo IO
              No mutations
              • Surgery
            • Surgery
              EGFR pos / ALK pos
              • Chemo IO
              • Chemo + Osimertinib
                EGFR pos
      • STAGE IIIA/IIIB
        • PDL1 status / Molecular profile
          • Resectable
            Thoracic solid tumour resectability in the ERA of Immunotherapy
            • Chemo IO
              No mutations
              • Surgery
            • Surgery
              EGFR pos / ALK pos
              • Chemo IO
              • Chemo + Osimertinib
                EGFR pos
        • Unresectable?
          • Chemo/RT
            IO
            • Salvage surgery
      • STAGE IIIB (N3) / STAGE IIIC / STAGE IVA/B
        • ChemoTHerapy +/- Immunotherapy
          • ? RT
  3. M
    0, 1a, 1b, 1c1, 1c2
    • STAGE
      Put in data to generate the stage
      • STAGE I
        • FIT
          • SURGERY
            • Algorithm for surgery - Coming soon
            • VATS/RATS
              • Lung resection
                Wedge / Segment / Lobectomy
                • Adjuvant treatment if upstaged
      • STAGE IIA/IIB
        • PDL1 status / Molecular profile
          • Resectable
            Thoracic solid tumour resectability in the ERA of Immunotherapy
            • Chemo IO
              No mutations
              • Surgery
            • Surgery
              EGFR pos / ALK pos
              • Chemo IO
              • Chemo + Osimertinib
                EGFR pos
      • STAGE IIIA/IIIB
        • PDL1 status / Molecular profile
          • Resectable
            Thoracic solid tumour resectability in the ERA of Immunotherapy
            • Chemo IO
              No mutations
              • Surgery
            • Surgery
              EGFR pos / ALK pos
              • Chemo IO
              • Chemo + Osimertinib
                EGFR pos
        • Unresectable?
          • Chemo/RT
            IO
            • Salvage surgery
      • STAGE IIIB (N3) / STAGE IIIC / STAGE IVA/B
        • ChemoTHerapy +/- Immunotherapy
          • ? RT
tosprivacyNon-Small Cell Lung Cancer NCCN GuidelinesESMO Clinical Practice Guidelines: Lung and Chest TumoursTreatment Choices for Non-small Cell Lung Cancer, by Stage