Lung Cancer Treatment
Non Small Cell Lung Cancer Treatment
In the past the standard lung cancer treatment for stages I and II disease was surgical resection. However, this often requires removal of an entire lung, which can compromise breathing. For patients whose lung function is already compromised, for instance by asthma or chronic bronchitis, lung surgery may not be possible. More recently high-dose radiotherapy using stereotactic radiotherapy has become an important new alternative with similar cure rates to surgery with less complications. Prof Nutting was one of the first doctors in the UK to deliver this treatment to patients using the Cyberknife system. For more advanced tumours, prolonged courses of radiotherapy is usually given as a daily treatment over about a six-week period (excluding weekends).
Chemotherapy is often recommended for more advanced disease, and is sometimes followed by either radiotherapy or surgery. A number of chemotherapy drugs have activity against lung cancer, and these may be combined in a ‘chemotherapy cocktail’ containing two or three different drugs. Most of these drugs are given by injection into a vein at intervals of between one and three weeks.
The current standard treatment used at the Royal Marsden Hospital is a combination drugs such as cisplatin or carboplatin combined with other drugs such as vinorelbine, gemcitibine or taxane. Treatment is given once every three weeks for a total of three to six cycles. It can be administered as a day case procedure, but many patients prefer to be admitted to hospital for one night. In some patients oral chemotherapy agents such as erlotinib (Tarceva) is used.
Small Cell Lung Cancer Treatment
Chemotherapy is usually recommended for this disease. The standard treatment at the Royal Marsden Hospital is with a regimen of two chemotherapy drugs, Carboplatin and Etoposide given as an intravenous injection every three weeks for a total of between four and six cycles. Etoposide tablets are also taken on days 2 and 3 of each cycle. For patients with limited stage disease, radiotherapy is also recommended following chemotherapy.
This is given to the initial sites of disease in the chest. In addition, radiotherapy to the brain is recommended to prevent disease relapse at this site, which is relatively immune to the effects of chemotherapy. This is because of the ‘blood-brain barrier’, a protective filter system that prevents toxins in our blood stream from poisoning the brain in usual circumstances.
Treatment of Mesothelioma
Surgical resection of mesothelioma is contemplated if the disease is confined to a limited area of the pleura. However, in the majority of cases surgery is not possible and treatment is therefore directed at control of tumour growth and alleviation of the symptoms of the disease. As with the other types of lung cancer a multidisciplinary approach is central to the treatment of individual patients.
A common feature of this disease is the accumulation of fluid in the chest surrounding the lung, known as a pleural effusion. This may result in difficulty with breathing, which can be alleviated by drainage of the fluid. To prevent recurrence of this problem, the lining of the lung may be sealed in a procedure called a pleurodesis, which is usually performed by our cardiothoracic surgical colleagues.
Following this kind of procedure, radiotherapy is recommended to the chest wall to prevent tumour from developing at the site of the surgical scar. Chemotherapy also has a role in controlling the symptoms of mesothelioma. Mitomycin C, Vinblastine Premarexed and Cisplatin are the drugs most commonly used (see section on treatment of non small cell lung cancer).