lung%20cancer
LUNG CANCER
Lung cancer is having a malignant tumor in the lungs especially in the cells lining air passages.
Primary tumor-related signs and symptoms are cough, dyspnea, hemoptysis, and chest discomfort.
Signs and symptoms due to intrathoracic spread may involve the nerves (hoarseness, dyspnea, muscle wasting of upper limb, Horner's syndrome), chest wall and pleura (chest pain, dyspnea) and vascular structures (facial swelling, dilated neck veins, cardiac tamponade) & viscera (dsyphagia).
The signs and symptoms due to metastatic spread are bone pain with or without pleuritic pain, neurologic symptoms, limb weakness, unsteady gait, cervical lymphadenopathy, and skin nodules.

Radiotherapy

Radiotherapy for Non-Small Cell Lung Cancer (NSCLC)
  • Used as an adjunct for patients with resectable lesions, as initial primary local treatment for medically unfit patients & with unresectable disease, & as a palliative modality for patients with advanced diseases
  • Can be given to patients with stage IV non-small cell lung cancer (NSCLC) with extensive metastasis as a palliative care
  • Concurrent thoracic irradiation & chemotherapy is superior to radiation alone or sequential chemotherapy followed by radiation in patients with locally advanced non-small cell lung cancer (NSCLC)
    • Consolidation Durvalumab after chemoradiotherapy is recommended for patients w/ stage III disease
  • Preoperative RT is recommended for patients w/ resectable superior sulcus tumors & may be considered inpatients w/ stage IIIA w/ minimal LN involvement & tumors candidates for lobectomy
  • Postoperative RT may be considered in patients w/ mediastinal involvement, multiple positive LN, extracapsular extension of LN, bulky LN, or w/ positive surgical margins

Interstitial Radiotherapy or Laser Therapy

  • Recommended for patients with recurrent NSCLC associated with endobronchial lesions

Radical Radiotherapy/External Beam Radiation Therapy (EBRT)

  • Recommended for patients with stage I & II who are not fit for or do not consent to surgery
  • Should be offered, in combination with chemotherapy, to patients with stage IIIA or IIIB non-small cell lung cancer (NSCLC) of good performance status (PS), in whom the tumor can be safely encompassed

Stereotactic Ablative Radiotherapy (SABR/BBRT)

  • Recommended for patients w/ stage I & IIA who are not fit for or do not consent to surgery
  • May also be considered for patients at high risk for complications following lobectomy (≥75 years old, poor lung function)

Palliative Radiotherapy

  • Fractionated, higher dose is recommended for patients with thoracic symptoms & good performance status but do not meet the requirements for radical radiotherapy for palliation of symptoms
Radiotherapy for Small Cell Lung Cancer (SCLC)
  • Since small cell lung cancer (SCLC) is radiosensitive, radiotherapy is a vital part of treatment
    • Important for palliation of symptoms in Extensive Disease Small Cell Lung Cancer (ED SCLC) patients with brain, epidural & bone metastasis
  • Radiotherapy, once started, should proceed without interruption
  • Advise patient to stop smoking prior to radiotherapy

Thoracic Irradiation

  • May be given to Limited Disease Small Cell Lung Cancer (LD SCLC) patients simultaneously with 1st or 2nd chemotherapy cycle
    • May also be given after completing chemotherapy if good response within the thorax is achieved
  • After completion of chemotherapy, radiotherapy may be offered to Extensive Disease Small Cell Lung Cancer (ED SCLC) patients provided a complete response on the distant sites & at least partial response within the thorax are achieved

Prophylactic Cranial Irradiation

  • Aims to eradicate microscopic brain metastasis in asymptomatic patients
  • Considered in patients with LD or ED SCLC of PS 0-2 in whom a complete response to primary treatment is achieved
  • Should be incorporated within 3-5 weeks of the last cycle of chemotherapy
  • Improves both disease-free & overall survival rates in patients with complete or partial response
  • Recommended after adjuvant systemic therapy in patients who had complete resection
  • Not recommended for patients with poor PS or impaired neurocognitive functioning
  • Increases the overall survival while decreasing the incidence of brain metastasis in patients with limited stage SCLC who responded to initial treatment
  • Decreases the incidence of brain metastasis in patients with extensive stage SCLC who responded to systemic therapy 

Palliative Radiotherapy

  • Recommended for patients with brain metastasis or those with localized symptomatic disease
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