Non-operative lung cancer management

Question 1

eastern cooperative group ECOG performance status measurement

Answer 1

0 = asymptomatic; well
1= symptomatic; able to do light work
2= has to rest but for <50% of the day
3= has to rest for >50% of the day
4= bedbound
5= dead

Question 2

Postoperative management of non-small cell lung carcinoma

Answer 2

chemo

radiotherapy - adjuvant RT

Question 3

what is Steroetactic Ablative Radiotherapy

SABR?

Answer 3

a way of giving radiotherapy to precisely target certain cancers

Can have similar outcomes to surgery
- Useful if not fit for surgery

Question 4

there is no neo-adjuvant chemotherapy in which stages of lung cancer?

Answer 4

1 and 2

Question 5

describe stage 3 non-small cell lung cancer

Answer 5

30% locally advanced: mediastinal/major vessel invasion or mediastinal nodes involved

Question 6

describe stage 4 non-small cell lung cancer

Answer 6

60%: distant metastases

incurable
palliation essential
radiotherapy to primary tumour - benefits symptoms

Chemo gives equal symptomatic benefit AND survival advantage

median survival is less than 12 months with chemo alone

Question 7

painful bone metastases should get how much radiotherapy? where and when do you get pain?

Answer 7

single fraction

pain can be anywhere, often worse at night

Question 8

brain metastases should get what treatment

Answer 8

resection - removal of part of it
radiotherapy 
steroids
or 
erlotinib - It is a receptor tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor (EGFR)

Question 9

targeted drugs for adenocarcinoma?

Answer 9

EGFR mutation: erlotinib, gefitinib, afatinib

ALK translocation: crizotinib, ceritinib

BRAF mutation: vemurafenib, dabrafenib

ROS alteration: crizotinib

Question 10

2nd line treatment for non small cell lung carcinoma?

Answer 10

docetaxel+/-nintedanib

pemetrexed
erlotinib

Question 11

small cell lung cancer

Answer 11

15% of patients
limited disease
extensive disease (more advanced)

Question 12

small cell lung carcinoma treatment

Answer 12

chemotherapy - treatment of choice

combo of drugs e.g cisplatin + etoposide

early thoracic radiotherapy is better

prophylactic cranial radiation (PCI)

Question 13

how is small cell lung carcinoma a limited disease?

Answer 13

No advantage from:-
High dose chemo
Alternating chemo
Maintenance chemo
Chemo ‘on demand’
Maintenance Interferon, MMPI, targeted therapies

Question 14

outcomes in limited disease SCLC?

Answer 14

Response rate 90%

Complete remission (getting rid of symptoms/pain temporarily) ~60%

Median survival (MS) with no treatment is 8 months

MS with treatment is 16 months

25% of patients have 2-year survival

Second line therapy suboptimal

Question 15

treatment of extensive disease SCLC?

Answer 15

4 cycles only of combination chemotherapy

Consolidation thoracic RT

PCI recommended (NEJM 2007)

Consider RT to palliate symptoms if not fit for chemo

Brain metastases? RT and steroids

Question 16

outcomes in extensive disease SCLC?

Answer 16

Response rate ~80%

Complete Remission in ~30%

Median Survival- no treatment ~8 weeks

MS with treatment ~8 months

Question 17

histological subtypes of lung cancer

Answer 17

non-small cell lung cancer - 85%

small cell lung cancer - 15%

Question 18

info about non-small cell lung cancer

Answer 18

129 days for cancer cell no to double
staging with TNM
max 25% is operable

Question 19

what is discussed at MDT (4)

Answer 19

Tumour type
stage
ECOG performance status
therapeutic options (taking into account patient wishes); aims of therapy (curative or palliative)

Question 20

non-small cell lung cancer- is surgery an option?

Answer 20

surgical survival depends on stage

5 year survival overall around 40%