Comprehensive treatment of lung cancer

  I. Surgical treatment of lung cancer Surgical treatment is the first and main treatment method of lung cancer, and the only treatment method that can cure lung cancer. The objectives of surgical treatment for lung cancer are: to completely remove the primary lesions and metastatic lymph nodes of lung cancer to achieve clinical cure; to remove most of the tumor to create favorable conditions for other treatments, i.e. subtotal surgery.  Reduction surgery: It is suitable for a few patients, such as refractory pleural cavity and pericardial effusion, to cure or relieve the clinical symptoms caused by pericardial and pleural cavity effusion, prolong life or improve the quality of life by removing the pleural and pericardial implant nodes and removing part of the pericardium and pleura. Decompression surgery requires concomitant local and systemic chemotherapy. Surgical treatment often requires preoperative or postoperative adjuvant chemotherapy and radiotherapy treatment to improve the cure rate of surgery and patient survival. The five-year survival rate of lung cancer surgical treatment is 30%-44%; the mortality rate of surgical treatment is 1%-2%.  For the second primary lung cancer occurring after complete lung cancer resection, as long as the lung cancer is suitable for surgical treatment, the patient’s visceral function can tolerate re-surgical treatment, and there is no technical problem in surgery, open-heart surgery should be considered to remove the recurrent lung cancer again.  Chemotherapy is the main treatment method for lung cancer, and more than 90% of lung cancers need chemotherapy treatment. The efficacy of chemotherapy on small cell lung cancer is more certain in both early and late stage, and even about 1% of early stage small cell lung cancer is cured by chemotherapy. Chemotherapy is also the main treatment for non-small cell lung cancer, and the tumor remission rate of chemotherapy for non-small cell lung cancer is 40% to 50%. Chemotherapy generally cannot cure non-small cell lung cancer, but can only prolong patients’ survival and improve their quality of life. Chemotherapy is divided into therapeutic chemotherapy and adjuvant chemotherapy.  Chemotherapy requires different chemotherapeutic drugs and different chemotherapy regimens according to different histological types of lung cancer. Besides killing tumor cells, chemotherapy also damages normal cells in human body, so chemotherapy needs to be carried out under the guidance of oncologists. In recent years, the role of chemotherapy in lung cancer is no longer limited to patients with inoperable advanced lung cancer, but is often included in the comprehensive treatment plan of lung cancer as systemic treatment. Chemotherapy can suppress the bone marrow hematopoietic system, mainly the decline of white blood cells and platelets, which can be treated with granulocyte colony-stimulating factor and platelet-stimulating factor. Chemotherapy is divided into therapeutic chemotherapy and adjuvant chemotherapy.  Radiotherapy is the most effective treatment for small cell lung cancer, followed by squamous cell carcinoma, and the worst for adenocarcinoma. The radiation field of radiotherapy for lung cancer should include the primary foci and the mediastinal area of lymph node metastasis. It should be supplemented with drug therapy. Squamous cell carcinoma has moderate sensitivity to radiation, and the lesion is mainly locally invasive and metastases relatively slowly, so it is mostly treated with radical treatment. Adenocarcinoma has poor sensitivity to radiation and is prone to bloodstream metastasis, so radiation therapy alone is less often used. Radiotherapy is a local treatment and often needs to be combined with chemotherapy. The combination of radiotherapy and chemotherapy can be synchronized or alternated depending on the patient’s condition.  2.Complications of radiotherapy Complications of radiotherapy for lung cancer include: radiation pneumonia, radiation esophagitis, radiation pulmonary fibrosis and radiation myelitis. The complications related to radiotherapy mentioned above are positively related to the dose of radiotherapy, and there are also individual differences.  Targeted therapy is one of the hottest treatments for lung cancer in the past decade. Genetic testing is the most effective means to indicate whether a gene is mutated or not, so as to improve the therapeutic effect of targeted drugs, instead of blindly targeting therapy. Therefore, genetic testing is the key to targeted therapy, and then the corresponding targeted drugs are selected, such as EGFR-TKI for EGFR mutation and ALK inhibitor for ALK mutation.  In addition, treatment for lung cancer also includes biological therapy, particle implantation and other treatment modalities. According to the patient’s specific situation, the effective combination of these treatments can significantly prolong the survival time and improve the quality of life by providing the best treatment for the patient.