non surgical treatment of non small cell lung cancer Flashcards
What are the top cancers?
Breast/Prostate followed by lung
What are the options for biopsy’s
EBUS, Bronchoscopy, guided CT or ultrasound
Tissue, then decide what? What % diagnoses?
Then decide if non-small cell lung cancer (approx 85%) or small cell lung cancers (appprox 15%)
When do you do a PET scan?
If you are considering radical surgerical treatment so that you have further information if the disease ahs become metastatic
What % patients are upstaged post PET
About 15%
If lymph node status still unclear, then what?
EBUS/mediastinoscopy to take samples to check
Who is at a MDT team and what do they present?
Respiratory team - present patient history, wishes, fitness ,performance status etc
Radiologists - discuss scans etc
Pathologists - discuss tissue etc
Surgeons/Oncologists to help decide the next stages
Performance measurement (again) what is it and what is it also known as?
ECOG - Eastern Corporate Performance status:
0 - no symptoms, no effect
1 - symptoms but can still do everything
2 - Can still do most things (>50%) but ha stopped work
3 - Can’t still do most things and needs help (<50%) more than half day in chair/bed
4 - Bed/Chair confined
NSCLC cell doubling time = ?
129 days
What % patients are potentially operable?
up to 25%
What is stage 4 cancer mean?
There has been distant metastatic spread
FEV requirements for pneumonectomy/lobectomy
Pneumonectomy = greater than 2 litres (so will be greater than 1 without one of the lungs) Lobectomy = greater than 1L
Why is lymph node sampling essential for surgery options
To check for metastatic spread that hasn’t been detected and avoid unneccesary surgery. Imaging isn’t a definite way of staging
Post operatively What is given to reduce risk of recurrence in stage 1B and 2
Adjuvant chemotherapy, reduces risk of reoccurance by 4.5-5% within 5 years
Adjuvent means? Neoadjuvently
Adjuvent = added on post operatively Neoadjuvent = before surgery
Is Neoadjuvent therapy routine before lung cancer surgery?
No, not at the moment
What is the aim in Radical radiotherapy for NSCLC
Radiotherapy given with curative intent
What happens in Radical radiotherapy NSCLC planning and how ling does it take?
The take another scan with the equipment that will be used for treatment to plan treatment. Takes about 2 weeks to plan. In this time they may be given Chemotherapy to take to start their treatment.
What is a fraction?
One dose of radiotherapy, radiotherapy is often given in 20 fractions, so once a day mon-fri for 4 weeks.
Side effects of radiotherapy?
Tiredness
If close to oesophagus may get oesophagitis - struggle to eat/drink
Breathlessness from pneumonitis.
Risk of pulmonary fibrosis, oesophageal stricture (narrowing) and cardiac problems.
5 year survival radical radiotherapy
Around 20%
What is SABR, how often is it given? Who is it given to? Can it have similar outcome for surgery?
Stereotactic Ablative Radiotherapy, normal does given in 3 fractions(!) V strong fractions. Only takes 1 week (M/W/F).
Given if:
Tumour under 4cm and more than 2cm away from airways and proximal bronchial tree
Unfit for surgery
Can have similar effect to surgery
Is Chemotherapy specific?
No, it’s systemic
Survival benefit at 5 years for adding Chemo onto radiotherapy for NSCLC
4-5% survival benefit
