Non small cell lung cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Surgical resection with mediastinal, peribronchial and perihiliar lymph node dissection is the preferred option. If the pathological evaluation of the dissected lymph nodes is positive to malignant neoplastic cells, the patient should be treated according to the Stage III treatment algorithm. If the tumor is inoperable, stereotactic ablative radiation therapy should be administered.
If the tumor is resectable, the preferred treatment for stage II non small cell lung cancer is surgical resection with lymph node dissection and pathological evaluation. If evidence of lymph node extension of the disease is present adjutant chemotherapy should be administered.
The treatment of stage III non smal cell lung cancer depends on the extension of the tumor. Chemotherapy and/or radiation therapy should be considered for patients with stage IIIB.
Local therapies (ambulatory catheter drainage, pleurodesis or mediastinal window) plus therapy for systemic metastasis is the preferred combination for patients with stage IV M1a non small cell lung cancer. Patients with solitary site metastasis (stage IV M1b) should be treated according to the site of metastasis.
The treatment of metastatic non small cell lung cancer depends on the site and extension of the disease. If specific mutations are diagnosed, treatment should be administered accordingly.
Chemotherapeutic regimens based on platinum agents have demonstrated longer survival rates, better symptom control and higher quality of life when compared with best supportive care.
Radiation therapy can be applied to any stage of non small cell lung cancer, according to the indications provided for each stage. Maximum tumor control with minimal tissue toxicity is the main goal of radiation therapy.