Week 4 - Non-Surgical Management of Lung Cancer Flashcards
When would we do a PET CT?
when were considering curative treatment to see metastasis and lymph node status
What is the ECOG?
eastern cooperative group performance. 0 is asymptomatic. 1 is light work, 2 is rest <50% of day, 3 is rest >50% of day, 4 is bed bound
How long does it take for NSCLC to divide?
129 days
When is surgery offered in NSCLC?
only as curative treatment - not palliative
What are the benefits of post-op chemo?
SLIGHTLY reduces risk of recurrence, increases chance of cure.
When is neoadjuvent chemo used and what is the benefit?
ONLY on stage III preoperatively - not I or II. advantages only minor
What is the purpose of radical radiotherapy? What are side effects?
high intensity with aim to cure.
Lethargy, eosophagitis (cant eat) and pneumonitis (SoB)
What is concurrent chemotherapy? Whats the effect?
chemo and radiotherapy together - or chemo then RT. Better than RT alone, but chemo increases toxicity
What is adjuvant immunotherapy and when is it carried out?
after treatment finishes. only stage II patients who have had concurrent chemo-radiotherapy
What is SABR radiotherapy?
stereotactic ablative RT. high dose and similar effect to surgery if patient isnt fit. tumour must be less than 4cm and at least 2cm from bronchus
What are the options for palliative treatment of NSCLC? (4)
chemo, palliative radiotherapy, immunotherapy and palliative TKI’s
What is the aim of palliative immunotherapy?
potentiates immune system by preventing T lymphocytes from being inactivated so they can detect cancer cells and act on them
What is the aim of palliative radiotherapy?
reduce pain/effects caused by metastasised tumours - e.g. bone pain, haemoptysis, cord compression. has survival advantage
What is the aim of palliative chemotherapy?
Has survival advantage - as long as QoL is okay and CT scans show active response to treatment
What is the doubling time of SCLC?
29 days - fast growing and metastasising.
When can we use curative treatment in SCLC?
if its early days or a limited disease (1 side of chest) using TNM ofc
How can we treat limited SCLC disease?
Chemo-radio therapy and prophylactic cranial irradiation - tendency to metastasise to brain, and as its small it can cross the blood-brain barrier
What is the outcome of chemo-RT in early limited SCLC?
8 month survival to 16 month survival with RT. 25% 2YSR
How can we treat extensive/very advanced SCLC disease?
combined chemo, w/wo RT. Also add prophylactic cranial irradiation. brain metastasis use TR and steroids
What is the outcome of treatment of extensive advanced SCLC?
median survival 8 weeks to 8 months with treatment
What are the side effects of chemo?
bone marrow suppression, nausea, vomiting, upset GI, fatigue, lethargy, nail and hair, neutropenic sepsis risk
What are the side effects of RT?
lethargy, risk surrounding organs, dysphagia, second malignancy risk
What are the side effects of immunotherapy?
Anything-itis
What is prophylactic cranial irradiation?
Radiotherapy used in SCLC to kill small cancer cells metastased to brain
