Non Surgical Management Of Lung Cancer Flashcards
How much lung cancer is non small cell
85% (adenocarcinoma then squamous then large)
Doubling time of non small cell lung cancer
129 days
How much non small cell lung cancer is resectable
25%
MDT meetings
Discuss staging, tumour type, PMH, ECOG performance status
ECOG
0-4, 4 is bedbound
5 year survival of NSCLC after surgery
40%
Adjuvant therapy for NSCLC surgery
Chemo eg cisplatin but NOT radiotherapy
Adjuvant immunotherapy
Pacific trial for durvlumab for stage 3 NSCLC, has no significant effect on QoL but improves survival
Neoadjuvant therapy for NSCLC surgery
Chemo for stage 3 and maybe radiotherapy
Radical radiotherapy for stage 3 NSCLC
55Gy dose, 20% 5y survival
SABR
Sterotactic ablative radiotherapy
54Gy in 3 fractions, can have similar outcomes to surgery for tumours up to 4cm and over 2cm away from airways and proximal bronchial tree
Advanced NSCLC occurence
In 80% of diagnosed patients. 30% in stage 3 have invasions and 60% in stage 4 have metastasis
Stage 4 NSCLC treatments
Incurable, only palliative care can be given up to 70% symptom benefit from RT but chemo gives this too plus survival benefit, increasing survival median to over a year
Treating stage 3 and 4 NSCLC
3 as good as 6 chemo rounds, immunotherapy can be used for metastasis
Bone pain from metastases timings, causes and treatment
Worse at night, pathological fractures, given palliative RT
New drugs for NSCLC
Targeted adenocarcinoma drugs for driver mutations eg erlotinib etc for EGFR, if patients can’t have chemo
Tyrosine kinase inhibitors examples and uses
Erlotinib, gefitinib, afatinib can improve response and survival in treating advanced solid tumours
Nivolumab
Blocks the binding of PD1 on T cells to PDL1 on tumours so T cells aren’t inactivated
Doubling time of SCLC
29 days
Treatment for LD SCLC
Chemotherapy combos eg cisplatin and etopisode, with early thoracic RT and prophylactic cranial RT
SCLC treatment outcomes for Limited Disease
Doubles survival median from 8 to 16 months, 90% response rate but 25% two year survival
Treatment for extensive SCLC
4 cycles of combo chemo with thoracic RT, PCI recommended (prophylactic cranial irradiation)
Outcomes of treated ED SCLC
80% response rate, median survival is 8 weeks without and 8 months with treatment, complete remission in 30%
Side effects of chemo
Marrow suppression, nausea, mucositis, fatigue, neuropathy, increased MI/stroke, renal impairment, hair loss and nail changes
Side effects of radiotherapy
Lethargy, risk to surrounding organs, pneumonitis, dysphagia (swalllowing difficulty), fibrosis, MI risk
Side effects of immunotherapy
Anything itis eg colitis
Lung cancer screening
Coming up, combines with smoking cessation interventions
