Treatment option guidelines for lung cancer

Question 1

SMALL CELL LUNG CANCER

Question 2

Treatment Guidelines- SCLC
early stage /localized disease
T1/2 N0 M0

Answer 2

Surgery if resectable

Post op chemotherapy
patients should be considered for PCI if they have a response to initial treatment.

Question 3

treatment guidelines-SCLC
Early stage/localised disease T1-4 N0-3 M0

Answer 3

-concurrent CRT (sequential if PS is worse)
-Thoracic RT should be initiated as early as possible (starting with the 1st/2nd cycle of chemo)
– Elective nodal irradiation depends on staging (PET +/- biopsy)

Question 4

NON SMALL CELL LUNG CANCER

Question 5

Treatment Guidelines- NSCLC
early staged disease (stage I and II)

Answer 5

surgery
NOT POSSIBLE = SABR
BED ≥100Gy

Question 6

SABR:
Common fractionations used in ireland are

Answer 6

60Gy/3#,
60Gy/5#,
60Gy/8#
34Gy/1#

Question 7

Treatment Guidelines- NSCLC
locally advanced stage disease (stage II-III)…. (N1-3) pt1

Answer 7

-IF Unresectable ….treated with CCRT
(66Gy in 33#)
-Cisplatin chemo recommended
-RT delivery should not exceed 7 weeks

Question 8

Treatment Guidelines- NSCLC
locally advanced stage disease (stage II-III)…. (N1-3) pt2

Answer 8

-patient not fit for CCRT=sequential accelerated RT schedules are recommended e.g. 66Gy/24#
-Consolidation Immunotherapy (to kill any cancer cells left in the body)

Question 9

Treatment Guidelines- NSCLC- Immunotherapy
locally advanced stage disease

Answer 9

In Lung often are Immune checkpoint inhibitors: basically take the ‘brakes’ off the immune system, which helps attack cancer cells. (PD1 and PDL1 )

Question 10

Treatment Guidelines- NSCLC
Metastatic Disease (Stage IV)

Answer 10

PALLIATIVE INTENT

systematic therapy is recommended
Chemotherapy OR
Targeted therapy/Immunotherapy if indicated -

EGFR mutated/ALK mutated/PD-L1 etc

Question 11

Metastatic Disease (Stage IV)
Role of Radiotherapy

Answer 11

– Symptom relief for
* Bone Pain
* Haemoptysis (coughing blood)
* SVCO
– Brain Mets: SRS for limited number of mets, WBRT if more 20Gy/5# or 30Gy/10#

Question 12

Metastatic Disease (Stage IV)
Tx N0 M1a=

Answer 12

contralateral lung, solitary nodule, no Nodes
Treat both a primary

Question 13

NSCLC
Oligometastatic Disease (Stage IV)

Answer 13

Systemic therapy and a radical local treatment (SABR/Surgery)

Question 14

NSCLC Overview
-early stage
-locally advanced

Answer 14

-Surgery or SABR

-ChemoRT (60-66Gy/30-33#) preferably concurrent+condsilation IO
if not fit for concurrent , sequential and accelerated RT (66Gy/24#)

Question 15

NSCLC Overview
Metastatic

Answer 15

Oligometastatic-Systemic treatment and SABR
More extensive Metastases- Systemic therapy (TT/IO/CT) and palliative RT if indicated