Non-operative Management of Lung Cancer

Question 1

What is adjuvant therapy?

Answer 1

therapy after surgery to attempt to increase chance of survival

Question 2

What is neoadjuvant therapy?

Answer 2

therapy before surgery to attempt to increase chance of survival

Question 3

What is the first line of treatment for patients with NSCLC?

Answer 3

surgery

Question 4

If a patient with NSCLC was unfit for surgery, how might they be treated?

Answer 4

radical RT e.g. SABR

Question 5

Does adjuvant radiotherapy increase survival in stage I and II NSCLC patients?

Answer 5

No - it is detrimental unless there is spread to mediastinal nodes or involves margins.

Question 6

Is neoadjuvant chemotherapy advantageous in NSCLC?

In which stages, if so?

Answer 6

Yes

Stage I and II

Question 7

How are patients with stage III NSCLC treated?

Answer 7

with radical chemoRT i.e. chemo and RT

Question 8

Neoadjuvant chemotherapy may have some benefits in NSCLC patients, but only when it is in which stage?

Answer 8

Stage 3 atleast

Question 9

How would you describe stage IV NSCLC?

Answer 9

incurable - palliative care only

Question 10

What is the treatment of stage IV NSCLC?

2

Answer 10

RT to primary tumour

chemotherapy to improve symptoms and give survival advantage.

Question 11

How many cycles of chemotherapy are given to patients with stage III and IV NSCLC?

Answer 11

3 cycles is as good 6, but 4 is the average in UK.

Question 12

What is the palliative therapy for bone mets?

3

Answer 12

RT
orthopaedic surgery
neurosurgeons for cord compression

Question 13

Describe the radiotherapy regime given to stage III NSCLC patients.

Answer 13

55Gy+
30 x 1/day (30 fractions)
12x 3/day (36 fractions)

Question 14

What must patients pass before being given radical radiotherapy?

Answer 14

pulmonary function test

Question 15

How would you describe the treatment for NSCLC?

Answer 15

curative/radical

Question 16

What would the first line of treatment for small cell carcinoma NOT be?

Answer 16

surgery

Question 17

How is SCLC treated?

Answer 17

chemotherapy and radiotherapy

Question 18

If a patient with SCLC was unsuitable for chemotherapy, how would they be treated?

Answer 18

palliative RT

Question 19

Where does SCLC often metastasise to?

What can be offered to treat this?

Answer 19

brain

PCI (prophylactic cranial radiation)

Question 20

What do small cell carcinomas often present with?

Answer 20

paraneoplastic syndromes e.g. Cushings, SIADH, limbic encephalitis

Question 21

What is limited disease in SCLC?

Answer 21

disease staged to one hemithorax

Question 22

What is the management of extensive disease SCLC?

Answer 22

4 cycles of combination chemotherapy