Surgery
- Performed in early stage non-small cell cancer (NSCC) (I, II, IIIA)
- Pts with stage III need chemoradiation to ‘downgrade’ the tumour to render it resectable
Radiation
- High dose radiotherapy or CHART (continuous hyperfractionated accelerated regimens)
- For pts with adequate lung function and early stage NSCC
- Treatment of choice when surgery is not possible due to comorbidities
- SE – radiation pneumonitis; radiation fibrosis
Radiation as a palliative treatment
- For pts with bone + chest wall pain from metastases
- Hemoptysis, occluded bronchi
- Superior vena cava syndrome
Chemotherapy + targeted drugs
- Adjuvant chemo + radio
- Cisplatin + pemetrexed
- Cisplatin + etoposide – for small cell cancer (SCC)
Targeted drugs
- Afatinib – EGFR TK inhibitor
- Crizotinib – ALK TK inhibitor
Laser therapy, endobronchial irradiation, tracheobronchial stents
- Used in the palliation of inoperable lung cancer
- In pts with tracheobronchial narrowing producing cough, dyspnoea, infection, haemoptysis, respiratory failure
- Neodymium (Nd-Yag) laser – passed through fibre-optic bronchoscope to vaporise intraluminal carcinoma
- Endobronchialirradiation (brachytherapy)
- Stent – made of silicone
SECONDARY TUMOURS
- Lungs are common site for mets from other primary tumours
- Common primary sites – kidney, prostate, breast, bone, GIT, cervix, ovary
- Mets are MC in lung parenchyma and can remain asymptomatic
- Mets in bronchi are rare
- Renal cell carcinoma most commonly causes a solitary round shadow on CXR in an asymptomatic patient. ( cannonball mets )