Pancoast tumor medical therapy: Difference between revisions

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==Chemotherapy with Radiation Therapy Regimens==
==Chemotherapy with Radiation Therapy Regimens==
===Chemotherapy plus Radiation Therapy===
===Chemotherapy plus Radiation Therapy===
The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>
The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] based on the 2014 NCCN Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>


*[[Cisplatin]] 50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through days 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]]
*[[Cisplatin]] 50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through days 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]]
Line 60: Line 60:


===Chemotherapy Followed by Radiation Therapy===
===Chemotherapy Followed by Radiation Therapy===
The list bellow show the options for [[chemotherapy]] followed by [[radiation therapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>
The list bellow show the options for [[chemotherapy]] followed by [[radiation therapy]] based on the 2014 NCCN Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>


* [[Cisplatin]] 100 mg/m<sup>2</sup> on days 1 and 29 + [[vinblastine]] 5 mg/m<sup>2</sup> per week on days 1, 8, 15, 22 and 29 followed by [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]].
* [[Cisplatin]] 100 mg/m<sup>2</sup> on days 1 and 29 + [[vinblastine]] 5 mg/m<sup>2</sup> per week on days 1, 8, 15, 22 and 29 followed by [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]].
Line 66: Line 66:


===Chemotherapy plus Radiation Therapy, Followed by Chemotherapy===
===Chemotherapy plus Radiation Therapy, Followed by Chemotherapy===
The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] followed by [[chemotherapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>
The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] followed by [[chemotherapy]] based on the 2014 NCCN l Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>


* [[Cisplatin]] 50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through day 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[cisplatin]] 50 mg/m<sup>2</sup> + [[etoposide]] 50 mg/m<sup>2</sup> to a total of 2 cycles.
* [[Cisplatin]] 50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through day 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[cisplatin]] 50 mg/m<sup>2</sup> + [[etoposide]] 50 mg/m<sup>2</sup> to a total of 2 cycles.

Revision as of 23:05, 24 February 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Overveiw

The optimal management approach of Pancoast tumor depends on a series of characteristics, that include pre-treatment evaluation, location, and adequate staging. Common treatment options for management include radiation therapy alone, radiation therapy and surgery, concurrent chemotherapy with radiation therapy and surgery, surgery alone (for selected patients).

Management Approach

The optimal management approach of Pancoast tumor depends on a series of characteristics, that include pre-treatment evaluation, location, and adequate staging. Common treatment options for management include:

  • Radiation therapy alone
  • Radiation therapy and surgery
  • Concurrent chemotherapy with radiation therapy and surgery
  • Surgery alone (for selected patients)


The treatment of a Pancoast lung cancer may differ to that of other types of non-small cell lung cancer due to its position and close proximity to vital structures (such as nerves and spine) which may make surgery difficult to be undertaken. As a result, and depending on the stage of the cancer, treatment may often involve radiation and chemotherapy given pre-operatively (neoadjuvant treatment) prior to surgery.

Medical Therapy

Chemotherapeutic Regimens

  • Chemotherapeutic regimens are based on platinum agents such as cisplatin, carboplatin, oxaliplatin, and satraplatin. Alternative regimens include paclitaxel, gemcitabine, or etoposide.
  • Chemotherapeutic regimens are adjusted based on individual characteristics and body surface. The regimen adjustment according to tumor evolution has demonstrated longer survival rates, optimal symptom control, and higher quality of life.
  • Shown below is a table depicting the different choices of regimens for the initial or adjuvant chemotherapy of patients with Panocast tumor. The list of regimens has been adapted from the 2014 NCCN Lung Cancer guidelines.[1][2]

Cisplatin Based Therapy

Agent Recommended regimen
Cisplatin 50 mg/m2 + vinorelbine 25 mg/m2 Cisplatin on days 1 and 8, vinorelbine on days 1, 8, 15, 22 and every 28 days to a total of 4 cycles
Cisplatin 100 mg/m2 + vinorelbine 30 mg/m2 Cisplatin on day 1, vinorelbine on days 1, 8, 15, 22 and every 28 days to a total of 4 cycles
Cisplatin 75-80 mg/m2 + vinorelbine 25-50 mg/m2 Cisplatin on day 1, vinorelbine on days 1, 8 and every 21 days to a total of 4 cycles
Cisplatin 80 mg/m2 + vinorelbine 4 mg/m2 Cisplatin on days 1, 22, 43, 64, then every 21 days to a total of 4 cycles, vinorelbine on days 1, 8, 15, 22, 29, every 2 weeks after day 43 until the completion of cisplatin treatmet
Cisplatin 100 mg/m2 + etoposide 100 mg/m2 Cisplatin on day 1, etoposide through days 1 to 3 and every 28 days to a total of 4 cycles
Cisplatin 75 mg/m2 + gemcitabine 1250 mg/m2 Cisplatin on day 1, gemcitabine on days 1, 8 and every 21 days to a total of 4 cycles
Cisplatin 75 mg/m2 + docetaxel 75 mg/m2 Cisplatin on day 1, docetaxel on day 1 and every 21 days to a total of 4 cycles
Cisplatin 50 mg/m2 + pemetrexed 500 mg/m2 Cisplatin on day 1, pemetrexed on days 1 and every 21 days to a total of 4 cycles

Alternative Regimen

Paclitaxel 200 mg/m2 on day 1 + carboplatin area under the concentration (AUC) 6 on day 1 and then every 21 days.[2]

Chemotherapy with Radiation Therapy Regimens

Chemotherapy plus Radiation Therapy

The list bellow show the options for concomitant chemotherapy plus radiation therapy based on the 2014 NCCN Lung Cancer guidelines.[2]

Chemotherapy Followed by Radiation Therapy

The list bellow show the options for chemotherapy followed by radiation therapy based on the 2014 NCCN Lung Cancer guidelines.[2]

Chemotherapy plus Radiation Therapy, Followed by Chemotherapy

The list bellow show the options for concomitant chemotherapy plus radiation therapy followed by chemotherapy based on the 2014 NCCN l Lung Cancer guidelines.[2]

References

  1. Alberti, W; Anderson, G; Bartolucci, A; Bell, D; et al. Chemotherapy in non-small cell lung cancer: A meta-analysis using updated data on individual patients from 52 randomised clinical trials. British Medical Journal, International edition311.7010 (Oct 7, 1995): 899
  2. 2.0 2.1 2.2 2.3 2.4 http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf

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