Lung cancer : journal of the International Association for the Study of Lung Cancer
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Percutaneous radiotherapy is an effective tool for the palliative treatment of patients with non-small-cell lung cancer (NSCLC). About two thirds of patients experience a notably improvement of symptoms after palliative radiotherapy. A whole variety of very different radiation schedules like a single fraction of 10 Gy, 2 fractions of 8.5 Gy, 10 fractions of 3 Gy, 25 fractions of 2 Gy, and others have been used for palliation. ⋯ Schedules like 2 x 8.5 Gy and 4 x 5 Gy are most appropriate in this situation. For patients with good performance status the choice of the optimal radiation schedule is less clear. Schedules with total doses between 30 and 45 Gy in 2.5-3.0 Gy fractions should be preferred in these situations.
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Despite advances in therapy, the prognosis of lung cancer remains dismal due to the fact that most cases of lung cancer are diagnosed at advanced stages, when the chance of cure is poor. In cases detected at early stages prognosis is better. Unfortunately, early lung cancer usually causes no symptoms and is, consequently, rarely diagnosed. ⋯ The rate of invasive procedures for benign lesions was low; most indeterminate lesions could be classified with non-invasive diagnostic approaches. The proportion of interval cancers (cancers diagnosed by symptoms between two screening CT scans) was low. As, however, these one-arm feasibility trials are not appropriate to assess a potential mortality reduction through CT screening, prospective randomised multicenter trials were recently initiated in several countries to analyse the effect of CT screening on lung-cancer mortality.
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Complete surgical resection remains the current standard of care for operable patients with stage-I or stage-II non-small-cell lung cancer. However, there is a strong rationale that supports the concept of the addition of systemic therapy to surgery either preoperatively or postoperatively even in patients with early-stage disease, as distant relapse continues to be the dominant form of relapse after surgical resection of NSCLC. ⋯ However, recently presented data of randomised phase-III trials showed an absolute survival benefit of 12-15% for patients with completely resected stage-IB and stage-II NSCLC receiving adjuvant platinum-based chemotherapy compared with observation alone. These trials provide resounding approval for adjuvant chemotherapy being the new standard of care for patients with early-stage non-small-cell lung cancer who have undergone complete resection of the tumour.
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The long-term results of surgery +/- radiotherapy in patients with operable disease of locally advanced non-small-cell lung cancer are discouraging. In the vast majority, disseminated microscopic disease, resulting in the later occurrence of distant metastases, contributes substantially to this poor long-term outcome. The further development of multimodality treatment approaches in randomised trials, including effective systemic therapy, is necessary. These approaches and the current status of multimodality treatment strategies of resectable locally advanced non-small-cell lung cancer are discussed.
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Brain metastases are a frequent complication in patients suffering from Lung cancer, and a significant cause of morbidity and mortality. Brain metastases are found in about 10% of patients at the time of diagnosis, and approximately 40% of all patients with lung cancer develop brain metastases during the course of their disease. The prognosis of these patients is rather poor. ⋯ Therefore, it seems justified to further evaluate the significance of chemotherapy compared to whole-brain radiation therapy. Whether chemotherapy alone is superior to whole-brain radiation therapy, or whether the combination of both therapeutic modalities should be preferred for the management of brain metastases, has not yet been proven, and further randomised phase-III studies are clearly needed. Based on the current available data, and the promising response rates in patients with lung cancer, chemotherapy should be considered for the management of brain metastases as part of a multimodality (or "interdisciplinary") treatment concept.