Doctors sometimes mention that “according to current international (national) guidelines, we should ……..”. . What are “guidelines”? Why should doctors “follow” the guidelines?
Guidelines are usually written by experts from professional medical groups and are updated regularly as new research evidence becomes available. The guidelines are a summary of the “best current research evidence and expert experience”. The current mainstream guidelines are the NCCN guidelines in the United States and the CSCO guidelines in China.
So what do the guidelines say about the treatment of limited-stage small cell lung cancer?
NCCN guidelines
The “jargon” of the specialty guidelines above is a little difficult to understand, so let me “translate” it for you. The term “limited stage small cell lung cancer” corresponds to stages I-III, which means that the lung cancer is located in one side of the chest and can be “fit” into a radiation field.
Surgeable
For these patients, if they are physically able to tolerate it, doctors usually recommend surgery to remove the diseased lobe and clear the surrounding lymph nodes to see if there is any tumor invasion. Postoperatively, chemotherapy is needed to reduce the chance of recurrence.
In the past, this was a major surgery that required an “open chest”. Nowadays, many hospitals can do “minimally invasive” surgery under the thoracoscope or with the help of a “robot”. The procedure can be done by making a few small holes in the chest wall and inserting instruments into the chest cavity.
Non-operable
If the lung is not functioning well or if there is medical disease (such as heart disease), the surgeon can also cure the tumor with a technique called “stereotactic radiotherapy. The company’s main goal is to provide a more accurate focus on the cancer and a higher single dose of radiation, which is equivalent to an invisible “radiation knife”. The doctor will also administer adjuvant chemotherapy after radiation therapy, or direct radical simultaneous radiotherapy.
Once a lymph node metastasis has occurred, surgery is not as meaningful for the patient. This is when your doctor may recommend “concurrent radiotherapy”, which means that chemotherapy and radiotherapy are given simultaneously. It takes advantage of both therapies to achieve a “1+1>2” effect.
Radiotherapy is the equivalent of the “air force,” which strikes the tumor with surgical precision and destroys the “enemy command” (the primary site of the tumor). The first of these is the “infantry regiment”, which is used to round up any remaining “enemy troops” (tumor cells in the bloodstream) after a full-scale war has begun. The first of these is a new one, which is a new one.
CSCO guidelines
For limited-stage small cell lung cancer, our guidelines are consistent with those of the NCCN. For patients without lymph node metastases, if physically tolerated, the surgeon’s first choice is surgical resection of the diseased lung lobe with clearance of the surrounding lymph nodes. After surgery, adjuvant chemotherapy is required to reduce the chance of recurrence.
If a patient has poor lung function or medical disease (such as heart disease), or has lymph node metastases that prevent surgery, radiation therapy is often used in combination with chemotherapy. The two are combined in “simultaneous radiotherapy”, which can fully utilize the advantages of both treatments to achieve a “1+1>2” effect. For patients in poor health who cannot tolerate the toxicity of concurrent radiotherapy, sequential radiotherapy (two treatments in sequence) is also an option.