non operative management of lung cancer Flashcards
what are the histological subtypes of lung cancer
non small cell lung cancer - 85%
- adenocarcinoma-55%
- squamous - 30%
- large cell in differentiation - 5%
- others <10%
small cell lung cancer - 15%
what are the values for ECOG
0 - asymptomatic; well 1 - symtomatic; able to do might work 2 - has to rest but for <50% of the day 3 - has to rest for >50% of the day 4 - bedbound 5 - dead
what is the doubling time of NSCLC and SCLC
NSCLC - 129 days
SCLC - 29 days
what must FEV1 be for a pneumonectomy
2
what is NSCLC adjuvant therapy
post operatively
chemotherapy - to increase chance of cure/reduce risk of recurrence
RT - adjuvant RT detrimental in stage 1 and 2: some benefit possible if mediastinal nodes or involved margins
what is neoadjuvant therapy
pre operatively
not used in clinical practice
stage 3: pre operative chemo demonstrates some advantages
there may be a role for targeted treatment/io neo adjuvant ly in the future
what is NSCLC radical radiotherapy
patients reviews in clinic to assess fitness then discuss plan then argent Rt for planning scan
variety of regimes
side effects:
- acute - lethargy, œsophagitis, SOB due to pneumonitis
- long term - pulmonary fribrosis. oesophageal structure, cardiac
5 ur survival rate is around 20%
pulmonary function tests essential
concurrent chemotherapy features
systemic treatment survival better than w RT alone addition of chemo increases toxicity no standard chemo regime each cycle 21 days radiotherapy planning process the same 2 yr survival is about 27%
what is PACIFIC trial
evidence for adjuvant durvlumab after CRT for stage 3 NSCLC
what is SABR
stereotactic ablative radiotherapy
can have similar outcomes to surgery
tumours up to 4cm
>2cm away from airways and proximal bronchial tree
what is palliative treatment
80% are not curable
stage iv- distant metastasis
stage iii - very locally advanced disease
treatment decisions also affected by co morbid disease
what are palliative care options
chemo immunotherapy TKI palliative radiotherapy combination of above
explain palliative chemo
given as a doublet regime
two drugs given as IV infusion every 3 weeks
4 cycles
quality of life should be measured
explain palliative immunotherapy
newish
PDL1 - (programmed death ligand) - protein that prevents immune system attacking cells in the body
cancers good at masking themselves from immune system via PDL1 expression
immunotherapy unmasks cancers
can be used in first like if PDL1 >50%
explain palliative TKIs
targeted drugs for adenocarcinoma with driver mutation
EGFR, ALK, BRAF, ROS
suitable for patients unfit for chemo
second line treatment options at progression
understanding mechanisms of resistant
