Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Lung Cancer 923

General Measures

■Thorough, rapid staging:

➣Non-small-cell lung cancer (NSCLC): TNM classification (T1–4,

N0-3, M0-1): lesions Ia – IIIa generally considered resectable/

curable

➣SCLC: limited vs extensive

Limited: confined to 1 hemithorax (radiation port)

Extensive: metastatic (majority of cases)

■PFTs if potentially resectable or having pulmonary symptoms

specific therapy

■Indicated for all patients: curative vs palliative

Treatment Options

■Surgery:

➣1/3 of patients with symptoms are resectable

➣NSCLC:

Indicated for patients Ia–IIIa

Neoadjuvant (preoperative) chemotherapy investigational but

promising

➣Lobectomy more effective that segmentectomy

➣SCLC: surgery with chemotherapy improves survival with coin

lesions

■Radiation therapy:

➣Less effective than surgery: important for patients with limited

pulmonary reserve, and preop for Pancoast tumors

➣Chemoradiation mainstay of therapy in limited stage SCLC.

➣Successful palliation for documented bone mets

➣Gamma knife brain irradiation useful in CNS met control

■Chemotherapy:

➣Cis-platinum regimens standard

➣Multiple newer agents (taxol, gemcitibine, navalbine, others)

with comparable benefits and varying side effects; survival and

cost effectiveness documented for stage IV NSCLC and good per-

formance status

➣Response rates 30–50%

➣Mainstay of treatment in SCLC with good rates response, symp-

tom control but eventual development of resistence

■Stents/laser therapy:

➣For obstructed bronchi, central tumors and collapse; endovas-

cular stents an option in SVC syndrome