Non operative management of lung cancer

Question 1

State non-surgical procedures for managing lung cancer ( NSCLC)

Answer 1

-TNM staging; surgery/radical radiotherapy( curative or palliative)

Question 2

State non-surgical procedures for managing lung cancer ( SCLC)

Answer 2

• defined as either limited/extensive ( extensive has a poorer prognosis)
• very aggressive cancer + sensitive to chemotherapy

Question 3

State the doubling time of NSCLC

Answer 3

-129 days

Question 4

State the performance statuses

Answer 4

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

Question 5

NSCLC: adjuvant therapy

Answer 5

• after surgery
• chemotherapy to increase chance in cure
• adjuvant radiotherapy(RT) detrimental in stage 1/2; can be beneficial if eiastinal nodes(N2)/involved margins

Question 6

NSCLC: Neoadjuvant therapy

Answer 6

• Before surgery
• stage 3: chemotherapy may have advantages.
• There is no neoadjuvant chemotherapy in stage 1/2
• induction chemotherapy used before RT

Question 7

Advanced staged NSCLC Stage 3: Radical radiotherapy

Answer 7

• over dose 55>Gy + chemotherapy

- pulmonary function tests required

Question 8

NSCLC Stage 3: ChemoRT

Answer 8

-survival better than RT alone

Question 9

SABR( steroetactic ablative radiotherapy)

Answer 9

• alternative not fit for surgery
• tumours up to 4cm
• needs to be >2cm away from airways and proximal bronchial tree

Question 10

NSCLC: advanced disease

Answer 10

• Chemo given to improve QoL - palliativie
• eliminate pain from bone metastases
• palliate brain metastases
• spinal cord compression
• compressive symptoms from visceral metastases ( airway obst. or GIT obs)
• uncontrolled bleeding - eg haemotypsis/haematuria

Question 11

Doubling time for SCLC

Answer 11

29 days

Question 12

What does the treatment depend on?

Answer 12

• ECOG performance status
• aptients wishes
• tumour type
• aims of team

Question 13

SMLC

Answer 13

Limited disease;

• combination chemo, early +concurrent RT better + cranial RT
• no benefit from high/alternating/maintainence chemo
• extensive disease; combination chemo only, single fraction RT to palliate if not fit for chemo
• brain met; RT + steroids

Question 14

Common side effects

Answer 14

• fatigue
• hair loss
• vomiting
• nausea

Question 15

Name the chemotherapy drugs + its function

Answer 15

SCLC
-Cis platin + etopside

NSLC + MESOTHELIOMA
- pemetrexed + maintainence chemo

Docetaxel, erlotinib, pemetrexed

SPECIFIC MUTATION
Getfitinib, IRESSA

Question 16

Radiotherapy dosesdivided into fractions

Answer 16

• high energy X-ray beam delivered by linear accelarator
• defined as dose of irradiation absorbed by each kg of tissue expressed as 1 Gy= 1J/Kg of itssue
• neoadjuvant + adjuvant or stand alone