Week 4 - Non-Surgical Management of Lung Cancer

Question 1

When would we do a PET CT?

Answer 1

when were considering curative treatment to see metastasis and lymph node status

Question 2

What is the ECOG?

Answer 2

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

Question 3

How long does it take for NSCLC to divide?

Answer 3

129 days

Question 4

When is surgery offered in NSCLC?

Answer 4

only as curative treatment - not palliative

Question 5

What are the benefits of post-op chemo?

Answer 5

SLIGHTLY reduces risk of recurrence, increases chance of cure.

Question 6

When is neoadjuvent chemo used and what is the benefit?

Answer 6

ONLY on stage III preoperatively - not I or II. advantages only minor

Question 7

What is the purpose of radical radiotherapy? What are side effects?

Answer 7

high intensity with aim to cure.

Lethargy, eosophagitis (cant eat) and pneumonitis (SoB)

Question 8

What is concurrent chemotherapy? Whats the effect?

Answer 8

chemo and radiotherapy together - or chemo then RT. Better than RT alone, but chemo increases toxicity

Question 9

What is adjuvant immunotherapy and when is it carried out?

Answer 9

after treatment finishes. only stage II patients who have had concurrent chemo-radiotherapy

Question 10

What is SABR radiotherapy?

Answer 10

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

Question 11

What are the options for palliative treatment of NSCLC? (4)

Answer 11

chemo, palliative radiotherapy, immunotherapy and palliative TKI’s

Question 12

What is the aim of palliative immunotherapy?

Answer 12

potentiates immune system by preventing T lymphocytes from being inactivated so they can detect cancer cells and act on them

Question 13

What is the aim of palliative radiotherapy?

Answer 13

reduce pain/effects caused by metastasised tumours - e.g. bone pain, haemoptysis, cord compression. has survival advantage

Question 14

What is the aim of palliative chemotherapy?

Answer 14

Has survival advantage - as long as QoL is okay and CT scans show active response to treatment

Question 15

What is the doubling time of SCLC?

Answer 15

29 days - fast growing and metastasising.

Question 16

When can we use curative treatment in SCLC?

Answer 16

if its early days or a limited disease (1 side of chest) using TNM ofc

Question 17

How can we treat limited SCLC disease?

Answer 17

Chemo-radio therapy and prophylactic cranial irradiation - tendency to metastasise to brain, and as its small it can cross the blood-brain barrier

Question 18

What is the outcome of chemo-RT in early limited SCLC?

Answer 18

8 month survival to 16 month survival with RT. 25% 2YSR

Question 19

How can we treat extensive/very advanced SCLC disease?

Answer 19

combined chemo, w/wo RT. Also add prophylactic cranial irradiation. brain metastasis use TR and steroids

Question 20

What is the outcome of treatment of extensive advanced SCLC?

Answer 20

median survival 8 weeks to 8 months with treatment

Question 21

What are the side effects of chemo?

Answer 21

bone marrow suppression, nausea, vomiting, upset GI, fatigue, lethargy, nail and hair, neutropenic sepsis risk

Question 22

What are the side effects of RT?

Answer 22

lethargy, risk surrounding organs, dysphagia, second malignancy risk

Question 23

What are the side effects of immunotherapy?

Answer 23

Anything-itis

Question 24

What is prophylactic cranial irradiation?

Answer 24

Radiotherapy used in SCLC to kill small cancer cells metastased to brain