The incidence and mortality rates of lung cancer have been increasing in the past 30 years or so at home and abroad, and this tendency is more obvious in developed countries. As the incidence of lung cancer is increasing, it is essential to find out the causes of the disease for prevention, but it is not effective in the short term. Therefore, it is imperative to carry out research on treatment to improve the effectiveness of lung cancer treatment so that patients can receive proper treatment.
Lung cancer treatment methods are divided into systemic and local treatment, the former includes chemotherapy, which has been widely used, biological immunotherapy and TCM, among which chemotherapy has obvious killing effect on cancer cells and is the most widely used, but has toxicity. However, the effect is slow, the repeatability is poor, and the efficacy is not yet satisfactory. Local treatment, including surgery and radiation therapy (radiotherapy), is limited. Before deciding on a treatment plan, it is important to understand that lung cancer is not a tumor confined to the lung, but has a tendency to invade surrounding tissues and organs and to metastasize along blood vessels and lymphatic vessels, and even stage I lung cancer may still have micrometastasis, such as adenocarcinoma at a very small size (2-3 mm). Therefore, the principle of lung cancer treatment should be based on the stage, type, extent of lesion, and organ function to provide local and systemic treatment.
The following is a brief introduction of chemotherapy, radiotherapy, surgery, biological therapy and multidisciplinary treatment.
I. Surgical treatment
1. The indications for lung cancer surgery are stage I, II and part of stage IIIa NSCLC, and the previous view that SCLC is not suitable for surgery has been broken. If chemotherapy is successful and the patient is young and in good general condition, surgery can be followed.
2, the surgical treatment plan is based on lobotomy, radical surgery requires complete removal of the primary focus, metastatic lymph nodes and invasive adjacent tissues visible to the naked eye.
3. Preoperative treatment has been emphasized in recent years, with the aim of reducing local lesions, improving the total resection rate and controlling micro-metastases. The preoperative chemotherapy for SCLC with large malignancy depends on the stage, and preoperative chemotherapy is not necessary for stage I SCLC; preoperative chemotherapy is preferred for stage II SCLC in China for the reason that intra-thoracic lymph node metastasis (N1) is present in stage II, and clinical staging is difficult. For stage III SCLC, radiotherapy is preferred after chemotherapy, and for those who are younger and estimated to be completely resectable after chemotherapy, surgical resection is pursued, and a 5-year survival rate of 27% has been reported. The results of a few reports are inconsistent and under active investigation. Preoperative radiotherapy can reduce the scope of quot;T”, but has no effect on “N2”. Recently, it has been reported that the use of interleukin II for three days before surgery for NSCLC can achieve better postoperative survival than the control group.
4.Postoperative treatment
For lung cancer that cannot be resected during surgery, the benefit of postoperative local radiotherapy has been recognized. Postoperative chemotherapy is very important in SCLC and has a great impact on survival and requires ≥3 cycles of chemotherapy. The necessity of postoperative chemotherapy for stage II and III NSCLC is more consistent, while stage I NSCLC is still debated.
5.Other
For elderly patients with lung cancer (≥70 years old) or poor cardiopulmonary function, if the lesion is ≤3 cm and the site is close to the chest wall, local resection is feasible, however, preoperative metastasis to intra-thoracic organs and the presence of N1 and N2 must be excluded. It is questionable whether intra-thoracic lymph nodes can be found and removed as clearly as open thoracic exploration. A randomized controlled study should also be conducted to observe the differences between conventional surgery and thoracoscopic small incision surgery in terms of survival, metastatic recurrence, consumption, outcome, patient KPS, quality of life, etc.
Second, radiation therapy (radiotherapy)
Radiotherapy is a local treatment which is widely used in lung cancer, mainly for stage III lung cancer and to relieve the symptoms of stage IV patients, including bone and brain metastases, to improve the quality of life and prolong life. In recent years, radiotherapy equipment has been gradually replaced, and almost all major cities in China have adopted linear gas pedals, however, there are still those who use drill 60.
1. Combined application of radiotherapy and chemotherapy for lung cancer
In recent years, through several international multicenter randomized studies, it is more consistent that radiotherapy combined with chemotherapy has a longer survival period than radiotherapy alone, which theoretically also suggests that the combination of radiotherapy and chemotherapy is beneficial. In the cell kinetic cycle, radiotherapy kills cancer cells at the late G2, M and G1 stages, and has no effect on the S stage, while the main effect of chemotherapy is the S stage, so radiotherapy can play a complementary role in killing cancer cells that are resistant to chemotherapy. In addition, tumor cells are heterogeneous and there are still lack of oxygen cells, which affects the sensitivity of radiotherapy. VPl6 enhances wild-type P53 and promotes apoptosis of tumor cells almost twice as much as normal conditions, and Tysol delays the growth rate of tumor cells by 2.4 times and enhances the sensitivity of radiotherapy by giving more opportunities for oxygenation of hypoxic cells.
Chemoradiotherapy is a keen clinical study at home and abroad, and it can be broadly divided into three forms: sequential (front-to-back sequential), synchronous and alternating chemoradiotherapy, although there is no definite evidence to confirm which one is better, most experts believe that synchronous chemoradiotherapy can improve local control rate and survival rate, and chemotherapy tends to use DDP as the main drug. The main drug of chemotherapy is DDP.
2.Intraoperative radiotherapy
The target group is mainly stage IIIb NSCLC with incomplete resection, and the aim is to improve the total surgical resection rate and reduce local recurrence. This is a one-time high-dose (15~25Gy) irradiation with electron wires at the residual site of surgery, and then external high-energy radiotherapy after the surgical wound heals, which has been developed in recent years.
3.Prophylactic irradiation to the brain (PCI)
Brain metastasis in SCLC can be 25%~37%, and it will increase with the prolongation of survival. 80% of brain metastasis in patients surviving for more than 2 years is still under study. The other 355 cases with PCI had a significantly lower rate of brain metastases, only 8%. The results of five randomized group studies of prophylactic brain irradiation from 1980 to 1993 showed that it significantly reduced the chance of brain metastasis, but did not improve the survival rate, therefore, the views are not unified. It is not meaningful for those who have complete control of lung lesions.
Chemotherapy
In the last decade, with the introduction of new effective anti-cancer drugs and the increase of new programs, the efficacy of chemotherapy has been significantly improved, and the remission rate (RR) of combined chemotherapy for SCLC has increased to 60%-90%, and CR has reached 30%-40%. The RR is 40%~60%, CR is 10%~20%.
1.Commonly used chemotherapy drugs for lung cancer
Cyclophosphamide (CTX), isocyclophosphamide (IFO), adriamycin (ADM), vincristine (VCR), vincristine (VBL), etoposide (VPl6), vimox (Vumon), carboplatin (CBP) and methotrexate (MTX) are commonly used chemotherapeutic drugs for SCLC, and the single drug RR is between 30-60%. The common drugs, such as chloramphenicol (DDP), are the most popular in the treatment of NSCLC and are considered to be the reason for prolonging the life of patients with stage IV NSCLC, and almost become an essential chemotherapy drug in the combination regimen of NSCLC. In addition, other single-agent RR≥15% for NSCLC chemotherapy drugs are IFO, VPl6, mitomycin (MMC), vincristine amide (VDS), ADM, epoetin (EPI), iso-vincristine, etc.
2.Introduction of new effective chemotherapeutic drugs for lung cancer
①Paclitaxel class: 2 drugs have entered the market, Taxol and Taxotere, both are new anti mitotic drugs developed after vincristine, which can promote microtubule dimer assembly and inhibit its multimerization.
②Camptothecin and its derivatives: It is the only topoisomerase I inhibitor among chemotherapeutic drugs that interferes with DNA replication. In recent years, a number of camptothecin derivatives have emerged, such as CPT-11 and Topotecan, which aim to reduce toxic side effects and improve efficacy.
③Gemcitabine (GEM): It is a purine pyrimidine analogue with a structure similar to that of cytosine, and is its fluorinated derivative, which is more likely to enter into cancer cells and accumulate, and is conducive to anti-cancer activity, and is an anti-metabolic drug.
④Iso-vincristine (NVB): It is a vincristine analog, with a single dose of 25-30mg/M2, and its main hematotoxicity is neutropenia and neurotoxicity.
⑤ Edatrexate (ETX): is a MTX derivative and a dihydrofolate reductase, single dose of 80mg/M2/W for 12 consecutive times, RR l0-30% in NSCLC, ETX combination regimen such as MMC, VBL (EMV regimen), RR 60%, but toxic reactions still become the reason for limiting the application.
(6) High-dose epirubicin (HD Epirubicin): Epirubicin is a dose-dependent drug, and high-dose EPI has been applied as a new drug in NSCLC in recent years.
3.Chemotherapy for metastatic (stage III~IV) lung cancer
The development of chemotherapeutic drugs around the 80’s obviously improved the effect on lung cancer, the most malignant SCLC is sensitive to chemotherapy, chemotherapy can prolong life. In 1982-1993, out of 8 international reports of 1400 cases of metastatic NSCLC, 6 results concluded that MST in the combination chemotherapy group was significantly better than that in the best supportive care group, with P values ranging from 0.005 to 0.05. . These chemotherapy regimens are all based on platinum-based drugs, and the improvement of survival in stage IV NSCLC is considered to be related to platinum-based chemotherapy drugs in the international evaluation.
4.High-dose chemotherapy with peripheral blood stem cell support
Generally speaking, the efficacy of chemotherapy is dose-related, and the literature reports that increasing the dose by 2-fold can increase the tumor-killing ability by 10-fold. High-dose chemotherapy overcomes drug resistance, but has large side effects. High-dose chemotherapy supported by peripheral blood stem cells provides an effective solution to the severe bone marrow suppression caused by chemotherapy, thus it is possible to achieve the efficacy that cannot be achieved by conventional dose through high-dose chemotherapy, SCLC is sensitive to chemotherapy and is the preferred target of high-dose chemotherapy supported by peripheral blood stem cells. High-dose chemotherapy supported by peripheral blood stem cells has been carried out at home and abroad, and the results of the study showed that it could increase the complete remission rate and disease-free survival of SCLC. Whether it can improve the long-term survival rate of SCLC is subject to further research and expansion of trials. In 1997, Shanghai Chest Hospital started to investigate the treatment of SCLC with peripheral blood stem cell support combined with high-dose chemotherapy, 19 cases have been completed so far, compared with 20 cases of SCLC treated with conventional chemotherapy in the same period, the RR of the two groups were 100% and 85%, 3 cases of CR (25%) and 6 cases of PR (75%) were treated with high-dose chemotherapy, the efficiency rate (CR+PR) was 100%, and the median survival was was 100%, and the median survival was better in the high-dose chemotherapy group, which was 18 and 11 months, respectively, which was statistically significant.
6.Special route of chemotherapy
(1) Intracavitary therapy
If the lesion of NSCLC is near the edge of the lung, it can directly invade the pleura or pericardium and constitute a large amount of pleural or pericardial effusion, especially the former is more common, because the effusion compresses the lung or heart and affects the function of organs, which obviously reduces the quality of life. In 1972, Shanghai Chest Hospital first used silicone tube to insert into the chest cavity to drain the chest fluid and then inject chemotherapy drugs or biological palliative modifiers (BMR), including DDP 60~80mg, MMC 6~8mg, ADM 60~80mg, etc. The remission rate can reach 60~90.1%, and can be injected again if necessary. Re-injection, the expansion of the lung after the effect is seen is beneficial to the exposure of the tumor in the lung, which is beneficial to the localization and evaluation of radiotherapy and chemotherapy, and also provides conditions for the next treatment of the primary tumor. If the amount of pleural effusion is greater than 2 intercostal spaces, it is suitable for thoracic drainage by intubation; less than 2 intercostal spaces, it can be injected by thoracentesis.
The side effects are mainly short-term fever and chest pain, etc. For cancerous pericardial effusion of medium amount or above, a thin tube is inserted to drain slowly, so as to avoid pumping the fluid too fast and inducing sudden decompression to lower cardiac output, which may lead to low volume shock and threaten to death. In addition, local lymph node and subcutaneous small node injection is also seen for clinical use.
(2) Bronchial artery chemotherapy
Selective bronchial artery infusion (BAI) antitumor drugs can increase the drug concentration in the target organs of tumor in the lung, which can improve the efficacy of chemotherapy in lung tumor. BAI is after all an invasive test, and after 2~3 times of bronchial artery infusion of chemotherapeutic drugs, most of the bronchial artery stenosis occurs, so that BAI can no longer be used. Although the local RR of BAI chemotherapy is better than that of systemic chemotherapy, however, lung cancer is a systemic disease, and only local treatment is insufficient. However, because of the good local effect, it should be beneficial to use as induction therapy. For stage IV lung cancer, the indication of BAI is less reasonable, but it can be used to alleviate the severe symptoms caused by the primary cancer lesion, and it may be more appropriate to use systemic chemotherapy in combination if allowed.
IV. Biological therapy
Biological therapy is a kind of treatment that expands its own immunologically active cells and enhances human body’s ability to kill tumor cells, which has high recognition power of its own tumor cells and low toxicity reaction. However, after years of clinical application, there are preliminary results that the mechanism of action is not only immunotherapy, but also anti-tumor neovascularization to control metastasis and recurrence. However, this does not mean that it can replace the current conventional lung cancer treatment.
Biological therapy for lung cancer is rarely reported clinically, but local treatment is widely used, such as injection of biological palliative modifiers (BRM) after drainage of cancerous pleural effusion, including CP (short cupped bacillus), OK432 (sapropterin), cytokeratin, high polyglucagon, interleukin II, interferon, LAK, mushroom polysaccharide, etc. There are no reliable randomized controlled studies on the systemic application of BRM. Cytokines are mainly used as adjuvant therapy, among which the most used is interferon (IFN), which can be divided into α-IFN, β-IFN and γ-IFN. Its application can be roughly divided into systemic therapy, radiotherapy, chemotherapy sensitization therapy and postoperative adjuvant therapy. The dose is 1~3 million/time, 2~3 times/week, subcutaneously or intramuscularly. Interleukin II (IL2) is the cytokine second to IFN in application to lung cancer, and in addition, IL2+LAK treatment for surgically resected incomplete stage III NSCLC has been randomly reported to improve postoperative survival.
Gene therapy can be broadly divided into gene replacement, gene modification, gene addition, gene supplement and gene flock, of which gene addition is the more popular gene therapy strategy at present. There are reports of 9 cases of NSCLC in which WtP53 was injected directly into the tumor and the percentage of apoptotic cells was found to be increased in 6 cases and the tumor shrunk in 3 out of 7 cases, which have entered preclinical trials, but there are no trials on the effects of appropriate delivery systems.
V. Multidisciplinary treatment
Multidisciplinary therapy is also called comprehensive therapy or multi-methodology therapy. In the long-term struggle between human beings and lung cancer, people have realized the inadequacy of any single therapy. As a result, the organic combination of local and systemic treatment was developed to bring into play their respective advantages and complement each other’s shortcomings. After years of clinical exploration, accumulation of experience and adjustment of strategies, a set of theories and methods has been gradually formed, and has achieved better efficacy in the actual treatment of solid tumors such as lung cancer. In recent years, multidisciplinary treatment has become the main trend of solid tumor treatment.
(A) Theoretical basis of multidisciplinary treatment for lung cancer
Lung cancer originates in bronchial and lung tissues, and has the characteristics of easily invading adjacent tissues or forming micro-metastases to distant places through blood and lymphatic tracts, thus causing treatment failure, which determines the complexity and difficulty of treatment. Currently, there are two kinds of treatment methods, including surgery, radiotherapy, BAI, etc., which have strong local effects on the primary foci, among which surgery is the most effective, as it can remove the primary cancer foci relatively cleanly as seen by the naked eye, but cannot detect the small amount of cancer cells invading outward. This is the limitation of local treatment; and surgical trauma can cause immune deficiency, which can lead to local recurrence and distant metastasis in the future. Systemic treatment includes chemotherapy, biological therapy and Chinese herbal medicine. Among them, chemotherapy is more mature, and they have the ability to inhibit and kill cancer fine run on both primary foci and micro-metastases, but they are not as targeted as local treatment on primary foci, and the control of toxic reactions has been greatly improved, but further improvement is needed. Therefore, according to the patient’s physical and mental condition and disease stage, combined with the biological behavior and development trend of lung cancer tissue types for comprehensive measurement, scientifically integrated the advantages of local and systemic treatment, and comprehensively planned multidisciplinary treatment plan, so that it has local and overall concept, in line with the clinical reality, and achieved better efficacy.
(II) Basic principles of multidisciplinary treatment
The disease examination can reflect the early and late stage of the disease and the degree of impact on the organism, combine with the patient’s physical and mental condition to make a comprehensive assessment, weigh the pros and cons, and develop a treatment plan, which is the basis of multidisciplinary treatment.
1. Determination of the histological type as an essential one in the development of multidisciplinary treatment.
Even if a specific type or clinical diagnosis cannot be distinguished, it should be distinguished as SCLC or NSCLC based on clinical course, imaging diagnosis and cellular and histological differentiation in order to develop a more correct and appropriate treatment plan.
2. It is important to make sure that the TNM staging and the disease stage are important conditions for the selection of multidisciplinary treatment methods.
TNM staging examination is decisive for determining the severity of the disease, selecting treatment methods and developing the best treatment plan. Clinically, there is no lack of rash surgery due to ignoring the staging examination, and metastases in brain and bone appear several months after surgery, resulting in patients receiving unnecessary surgical pain and even accelerating the deterioration of the disease. Clinical staging is less accurate than surgical staging and pathological staging, but it can determine the size of the primary lesion, the extent of the lesion and the presence of distant organ metastasis earlier, and it is decisive to consider what is appropriate for local or systemic treatment.
3. Patient-centered.
Various treatments for lung cancer have certain damage to patients, such as the trauma of surgery and the toxic side effects of radiotherapy and chemotherapy, which are worth considering whether patients can tolerate them. Therefore, before treatment, it is necessary to understand the physical condition of the patient, including age, gender, KPS score, various tests including blood picture and determination of important organ functions such as heart, lung, liver and kidney, and to understand whether there are other concomitant diseases. In addition, the mental psychological condition should also be noted, some patients can be pessimistic and desperate due to their condition, give up the diagnosis and treatment and lose the chance of treatment.
(3) Deep understanding of the refractory nature of lung cancer
1. Heterogeneity of cancer cells exists. Heterogeneous cancer cells have different sensitivities to chemotherapy and radiotherapy, and when sensitive cancer cells are killed, heterogeneous cancer cells are stimulated by feedback and proliferate a lot to replenish, which is more prominent in NSClC and is a difficult problem in treatment.
2. Paying attention to the biological behavior of lung cancer cells helps to estimate the development trend of the disease Different tissue types of lung cancer have different biological behaviors. The biological behaviors of SCLC can be evaluated in terms of doubling time (TD), rapid metastasis, systemic condition, malignancy and sensitivity to radiotherapy and chemotherapy, etc. SCLC has the shortest doubling time (75.9 days), rapid growth, rapid metastasis and high malignancy, but is the most sensitive to chemotherapy and radiotherapy, so chemotherapy is an essential part of SCLC treatment. Squamous cell carcinoma has an intermediate multiplication time of 92 days, with localized growth and slow metastasis, and is less sensitive to radiotherapy and chemotherapy than SCLC and stronger than lung adenocarcinoma. Although the primary foci are not fast growing and sometimes show slow growth, they are prone to distant metastasis. In addition, there are many mixed types of lung cancer, about 40% of squamous carcinoma and adenocarcinoma are mixed with another type under electron microscopy, and the resolution of light microscopy is lower than that of electron microscopy. For example, in SCLC, only 1.2% of the initial patients are mixed type, and 6% of the pure SCLC is transformed into small-large cell type after radiotherapy.
More than 50% of surgical specimens of SCLC after chemotherapy were mixed with adenocarcinoma or squamous cell carcinoma. These changes in tissue type are also one of the reasons for changing the sensitivity to chemotherapy, which is a difficult problem for treatment, and the above situation should also be considered in the treatment.
3. Molecular biology expression of lung cancer is related to the sensitivity of chemotherapy and radiotherapy
For example, K-ras gene expression in adenocarcinoma is highly malignant and insensitive to radiotherapy and cisplatin, and overexpression of CerbB2 gene in lung adenocarcinoma has the characteristics of easy infiltration and intrinsic drug resistance. Primary SCLC with N-myc overexpression suggests strong infiltration and insensitivity to chemotherapy. These changes in the molecular biology of lung cancer can be used as a genetic level to determine the sensitivity to chemotherapy and radiotherapy, which is of practical value for guiding treatment.
4. Drug resistance of lung cancer cells
With the wide application of antitumor drugs, drug resistance has become one of the most common and difficult to overcome problems of clinical cancer chemotherapy failure, which can be divided into two types according to the nature of drug resistance: (1) intrinsic or primary drug resistance: high tolerance to drugs is demonstrated from the beginning of treatment; (2) acquired or secondary drug resistance: drug resistance is gradually developed after treatment, and the proportion of resistant cancer cell subpopulations increases. The cause of drug resistance is the result of a combination of factors, including tumor cell heterogeneity and intrinsic environmental factors related to patient age, organ function, enzymes and endocrine, among which the drug resistance of tumor cells is especially correlated with gene amplification and its expression products. It is now known that P-glycoprotein genes are known as mdr multidrug resistance genes, in which mdrl gene expression level is proportional to multidrug resistance in human cancer cells, and its copy number can be amplified tens or even hundreds of times, and P-g expression in resistant cell lines can be elevated to 70% of the total cell membrane protein amount, and the tolerated chemotherapy dose increases to hundreds or thousands of times, and P-g expression is significantly higher in NSCLC specimens than SCLC. This is consistent with what is seen clinically, but the different levels of P-g expression in different parts of the same specimen suggest the uneven distribution of P-g expression. Glutathione S-transferase is an enzyme that has the effect of inactivating and eliminating harmful substances in normal human body, also including anti-cancer drugs, if its content is too high, it will definitely reduce the effective effect of chemotherapeutic drugs, glutathione (GST) has 3 isozymes.
Among them, GSTα increases the resistance to alkylating agents and anthraquinones, GSTЦ is related to the resistance to nitroso anticancer drugs, GSTII is the most common isoenzyme in tumor tissues, and it is related to cisplatin resistance, in addition, it is also related to mitomycin (MMC), vincristine (VCR) and adriamycin (ADM) resistance. The expression of GSTΠ in 44 specimens of NSCLC was measured in Shanghai Chest Hospital, and the results showed that the expression of GSTΠ in tumor cells at the primary site was lower than that in intrathoracic lymph nodes, 25% and 60%, respectively, and the expression was higher in late stage. In conclusion, the determination of drug resistance genes provides information for the selection of chemotherapeutic drugs, which can be used to improve the effect of chemotherapy, and is currently under active research.
5.Lung cancer has abnormal active angiogenesis
The vascular endothelial cells in normal tissues are in a proliferative resting state and only need to be renewed once every few months or even years. However, in lung cancer, vascular proliferation is abnormally active, and this excessive angiogenesis provides nutrition for the rapid growth of tumor cells. The amount of tumor neovascularization is closely related to the existence and metastasis of micrometastases, which is also one of the main causes of recurrence and metastasis. Many literatures report that vascular endothelial growth factor (VEGF) is the main positive regulator of tumor angiogenesis in lung cancer, which is also widely valued. Shanghai Chest Hospital analyzed the effect of VEGF and several biologic factors (such as tumor microvessel density MVD, P53, PI, DI) combined with VEGF on postoperative survival in 127 cases of surgically treated I~IIIa NSCLC, and the results showed that the survival rates of high and low VEGF expression l and 2 years were similar, and the survival rates of 3, 4 and 5 years were lower for those with high expression, but not statistically significant, P = The difference in survival rates between high and low VEGF expression in stage I NSCLC was found to be more significant than that in stages II and III, P = 0.0643, which was nearly significant. and 35.71%, 38.26%, and
The 5-year survival rates were 64.1% and 35.71%, 38.26% and 36.36%, respectively, which were statistically significant, with P = 0.0322 for COX univariate analysis and P = 0.0239 for multivariate analysis. The above results support that using a single VEGF as a prognostic indicator for NSCLC is insufficient, and the combination of P53 or PI can show a correlation with prognosis.
Although there are many reports in the literature on how to control tumor angiogenesis, most of them are experimental studies, and there are many known inhibitors with angiogenesis inhibitory effects, such as heparin, tumor necrosis factor (TNF), interferon (αIFN), etc., which are still few in clinical research applications. In our hospital, a randomized study of 29 cases after stage I NSCLC, αIFN was used as postoperative adjuvant therapy, and the five-year survival rate after surgery was high.
(D) Organic combination of local and systemic therapy is the core of multidisciplinary treatment
The mechanism of action of local and systemic therapy is different, and each has its own strengths and weaknesses, so how to optimize the combination of local and systemic therapy according to the different time periods, and better play the complementarity of the two, so there are various forms of combination programs. From the type, disease stage, systemic condition, organ function, disease duration and other comprehensive analysis, determine the treatment plan, trying to find the most suitable treatment mode, but also can further improve the efficacy. If SCLC is highly malignant and has a high propensity for systemic and local metastatic invasion and is sensitive to chemotherapy, chemotherapy should be the mainstay regardless of the stage except for stage I. Local treatment, including surgery or radiotherapy should still be recommended after effective chemotherapy below stage III in order to remove the 25% possibility of local recurrence after chemotherapy, and chemotherapy should still be given after surgery or radiotherapy in order to prevent the development of micrometastases. Low-dose interferon may be considered at the end of the treatment regimen. These are the main clients of current multidisciplinary treatment research, which enriches the connotation of multidisciplinary treatment and promotes the development of multidisciplinary treatment.
In conclusion, multidisciplinary treatment has its theoretical basis and is in line with clinical practice, and there is a set of objective methods to assess the patient’s body, mind and condition. Therefore, multidisciplinary treatment is well-conceived, scientific and has certain rules to follow, and is never an arbitrary combination of local and systemic treatment.
(E) Research of multidisciplinary treatment plan
Surgery, radiotherapy and chemotherapy are the three pillars of tumor treatment, and they are also the main methods in multidisciplinary treatment plan. With the development of biotechnology, many biologic products such as interferon, interleukin, tumor necrosis factor, etc., and immunologically active cell transfusion techniques such as IL-2/LAK have been selected for clinical application to participate in the multidisciplinary treatment program, and have achieved some good results.
1.Multidisciplinary treatment of NSCLC
(1) Pre-surgical treatment: The effect of surgical treatment on stage IIIa. patients is poor, especially the presence of N2 (mediastinal lymph node metastasis) is the main cause of poor prognosis. Therefore, preoperative chemotherapy or radiotherapy has been repeatedly reported in order to alleviate the disease and improve surgical resection and survival rates. A total of 175 cases of surgically resectable stage IIIa NSCLC were studied in 2 units for preoperative treatment, and the MVP regimen (mitomycin, vincristine, cisp