Non-small cell lung cancer (NSCLC) does not respond well to chemotherapy, so surgery is the best treatment option, but it is less effective except in limited tumors. Radiotherapy is effective in a minority of cases and is palliative in most cases, and chemotherapy generally improves survival and provides symptomatic relief in advanced cases.
There are two major issues to consider when preparing surgical treatment for lung cancer, namely resectability and operability. Resectability is based on its stage and needs to take into account the organs invaded, metastasis or not, and its location. Surgical capacity refers to the patient’s ability to undergo surgery and the subsequent reduction in lung volume and function, and a series of preoperative examinations assess the patient’s general condition. The type of resection used depends on the location and size of the tumor; lobectomy is the removal of the complete lobe, segmental resection is the removal of the bronchopulmonary segment, wedge resection is used for small peripheral tumors, wedge resection of lung tissue, and sleeve resection is used for tumors involving the main bronchus. These procedures are often done in an open-chest fashion, but thoracoscopy (VAT) has been widely performed in our hospital and some other hospitals. the advantages of VATS surgery are less trauma to the patient, very little tissue is cut, and there is less impact on lung function after surgery.
The following are the recommended treatments based on the treatment protocols proposed by the National Cancer Institute
Stage 0 NSCLC can be surgically resected.
Stage IA and IB
Surgery is the treatment of choice for patients with stage IA and IB NSCLC. Patients who are inoperable or have positive margins may be treated with radiation therapy, which generally increases the 5-year survival rate. patients with stage IIB resection should consider experimental chemotherapy to reduce the chance of metastasis, but current adjuvant radiation therapy makes the survival rate even lower.
Stages IIA and IIB
Stage IIA and IIB NSCLC with curative surgery, radiotherapy and postoperative clinical trial adjuvant chemotherapy and radiotherapy are basically similar to stage IA and IB NSCLC, and, patients should be carefully evaluated preoperatively. Supraglottic sulcus tumors are often difficult to manage due to heavy local invasion and few distant metastases, therefore, local treatment of these tumors seems to be more able to achieve therapeutic goals. Preoperative simultaneous radiotherapy and surgery may achieve therapeutic results in some cases, and direct invasion of the chest wall by tumors, using resection surgery, can often achieve curative results in some patients.
Stage III (IIIA, IIIB): Patients are recommended to undergo preoperative simultaneous radiotherapy or simple simultaneous radiotherapy.
Patients with stage IIA IIIA NSCLC have a poor prognosis; however, 5% to 10% of patients treated with radiation have long-term survival. Combination therapy is currently recommended for such patients to improve the survival of such patients. Surgery alone is indicated for a specially selected subset of cases, and preoperative concurrent radiotherapy helps to control local tumors after surgery, and chemotherapy is required after surgery.
Stage IIIB The best treatment for stage IIIB is chemotherapy and radiotherapy alone, or in combination, depending on the site and characteristics of the tumor. Most cases with good outcome are treated with combination therapy, which can reduce the mortality rate by 10% compared to radiotherapy alone, and the cases with poor outcome are mostly patients treated with palliative radiotherapy.
Patients with stage IV IV are suitable for chemotherapy and can also be treated with radiotherapy to relieve local symptoms with palliative treatment, even though its effect is limited and has a high risk and side effects, and there are multiple combination regimens with similar efficacy.
Targeted therapy for non-small cell lung cancer.
From the results of clinical studies at this stage, the efficiency of targeted therapy is not very high, and we do not understand enough the specificity of targeted therapy. The targeted drug therapy is not well targeted and the results are still unsatisfactory.
Treatment of II small cell lung cancer (SCLC).
The following recommended treatments are the treatment principles proposed by the National Cancer Institute.
The stage and histologic classification of the tumor are very important factors in determining the treatment plan, as most patients have underlying and obvious metastases at the time of diagnosis. There is no significant difference in survival in less-differentiated stages; therefore, the actual treatment of patients with small cell lung cancer is not based on the complex TNM staging system mentioned previously, but most often on diffuse and limited stage staging.
Limited stage SCLC.
Only 1/3 of patients are in limited stage at diagnosis, and chemotherapy is the mainstay of treatment for limited stage SCLC. Patients in complete remission with chemotherapy still have central nervous system (CNS) involvement in 35% to 65% of patients 2 years after treatment, so prophylactic cranial radiotherapy (PCI) is often required for patients in complete remission as well.
Diffuse stage SCLC.
Chemotherapy regimens for patients with diffuse stage are similar to those used for patients with limited stage, and chest radiotherapy is rarely used due to extensive metastases. Therefore, treatment is primarily chemotherapy. Metastatic sites that do not immediately resolve with chemotherapy, especially brain, epidural and bone metastases, require radiotherapy.
Biologically targeted therapeutic agents: gefitinib. tarceva. avastin, bevacizumab. bufotanine, etc. are used to treat non-small cell lung cancer.