Neoadjuvant Therapy

See the current version of the SEER Program Coding Manual under Reporting Guidelines, Section VII: First Course of Therapy, for complete coding instructions for the neoadjuvant data items. See also Appendix C.

Neoadjuvant therapy is used to shrink the tumor, which is then followed by surgery.

For lung cancer, neoadjuvant therapy may be used for resectable tumors, particularly when ipsilateral lymph nodes are involved. It can include chemotherapy, radiation, and/or immunotherapy.

Numerous treatment options are currently available to reduce the risk of recurrence in patients with early-stage resectable non-small-cell lung cancer (NSCLC). These approaches include neoadjuvant therapy and adjuvant therapy, which have been shown to improve outcomes in patients undergoing surgery.

If neoadjuvant therapy is followed by surgery, do not record the size from the pathologic specimen. Code the largest size of tumor prior to neoadjuvant treatment; if unknown code size as 999.

Neoadjuvant therapy is systemic therapy that is administered prior to surgical resection. This may include chemotherapy, hormone, immunotherapy and/or radiation. For a treatment to be noted as neoadjuvant therapy, it must meet the treatment guidelines. (See Non-Small Cell Lung Cancer - Guidelines Detail or Small Cell Lung Cancer - Guidelines Detail to determine the appropriate guidelines for neoadjuvant therapy.)

If only systemic therapy (chemo, hormone, immune) or radiation are given (no surgical resection), then this is not neoadjuvant therapy.

Document neoadjuvant therapy details in NAACCR Item #’s (as applicable)

• #1632: Neoadjuvant Therapy
• #1633: Neoadjuvant Therapy-Clinical Response
• #1634: Neoadjuvant Therapy-Treatment Effect
• #2620: Text-Radiation (Beam)
• #2630: Text-Radiation Other
• #2640: Text-Chemo
• #2650: Text-Hormones
• #2660: Text-BRM
• #2670: Text-Other

See Additional Resources for Lung Cancer Treatment

Updated: April 8, 2026