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 and with unresectable disease, as definitive therapy for locally advanced NSCLC, treatment recurrences and metastases, and as a palliative modality for patients with advanced diseases
  • Preoperative RT is recommended for patients with resectable superior sulcus tumors and may be considered inpatients with stage IIIA with minimal LN involvement and tumors candidates for lobectomy
  • Postoperative RT may be considered in patients with mediastinal involvement, multiple positive LN, extracapsular extension of LN, bulky LN, or with positive surgical margins
  • Can be given to patients with stage IV NSCLC with extensive metastasis as a palliative care

Radical Radiotherapy/External Beam Radiation Therapy (EBRT)

  • Recommended for patients with stage I and 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 NSCLC of good performance status (PS), in whom the tumor can be safely encompassed

Stereotactic Ablative Radiotherapy (SABR/BBRT)

  • Recommended for patients with stage I and 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)

Definitive Chemoradiation 

  • Recommended for patients with stage II-III NSCLC with unresectable disease
  • Superior to radiation alone or sequential chemotherapy followed by radiation in patients with locally advanced NSCLC
  • Preoperative concurrent chemoradiation is recommended for operable superior sulcus lesions and may be considered in operable stage IIIA lesions
    • May also be given postoperatively or in trimodality therapy
  • Consolidation Durvalumab after chemoradiotherapy is recommended for patients with stage III disease
  • Recommended dose: 60-70 Gy in 2 Gy fractions

Interstitial Radiotherapy or Laser Therapy

  • Recommended for patients with recurrent NSCLC associated with endobronchial lesions

Palliative Radiotherapy

  • Fractionated, higher dose is recommended for patients with thoracic symptoms and good performance status but do not meet the requirements for radical radiotherapy for palliation of symptoms
  • Higher dose or longer courses are recommended (eg ≥30 Gy in 10 fractions) modestly improves patient survival and symptoms
Radiotherapy for Small Cell Lung Cancer (SCLC)
  • Since 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 and 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 ED SCLC patients provided a complete response on the distant sites and 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 or partial response to primary treatment is achieved
  • Should be incorporated within 3-5 weeks of the last cycle of chemotherapy
  • Improves both disease-free and 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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