MODERN DIAGNOSIS
AND TREATMENT
OF LUNG CANCER
Department of Thoracic Surgery,
General and Oncology Surgery
Medical University in Łódź
Author: M.D. Sławomir Jabłoński
LUNG CANCER
EPIDEMIOLOGY
ONE OF THE MOST FREQUENT MALIGNANT
NEOPLASMS IN HUMANS
FIRST cause of death in males
THIRD cause of death in females
EUROPE : 21% of all cancer cases,
29% of all cancer deaths
POLAND
NEW CASES
DEATHS
20 000/year
nearly 20 000/year
M:F ratio = 5:1
LUNG CANCER
- DEFINITION
Primary lung cancer is a malignant
neoplasm originating from epithelial
cells of bronchial tree or other cells
of the lung tissue
Lung cancer is divided into two large groups
LUNG CANCER
NON-SMALL CELL
LUNG CANCER
75%
PLANOEPITHELIAL CARCINOMA
50%
ADENOCARCINOMA
20%
LARGE CELL CARCINOMA
20%
MIXED CARCINOMA
CARCINOID
BRONCHIALVEOLAR CARCINOMA
10%
SMALL CELL
LUNG CANCER
25%
MIXED OAT CELL
CARCINOMA
INTERMEDIATE CELL CARCINOMA
OAT CELL CARCINOMA
CHARACTERISTICS OF PATHOLOGICAL
TYPES OF LUNG CANCER
TYPE OF
CANCER
MAIN
TYPE OF
CELLS
MICROCELLUL
AR
CARCINOMA
Small cells;
subtypes ;
oat cells,
medial
FREQUENCY
20- 25%
LOCATION
HISTOLOGY
CENTRAL
Undifferentiate
d giant cells
10%
Giant cells
PERIPHERAL
NON-
MICROCELLULAR
CARCINOMAS
Adenoidal
cells;
Subtype:
bronchioalveolar
25-30%
planoepithel
ial
30-35 %
PERIPHERAL
CENTRAL –
large and
medial bronchi
Adenoidal
formations;
Intracellular
mucus
Intercellular
connections
(desmosoms)
Keratinous
pearls
TIME OF
DUPLICATIO
N OF TUMOR
MASS
( IN DAYS)
33
MOTHER CELLS
Neuroectodermal
Kulczycki cells
100
187
Goblet cells
100
Multipotential
cells
SMALL CELL LUNG CANCER
Definition
Small cell lung cancer (SCLC) is a fast-growing type
of lung cancer. It tends to spread much more quickly
than non-small cell lung cancer.
Causes
About 15% of all lung cancer cases are small cell lung cancer.
Small cell lung cancer is slightly more common in men than women.
Smoking almost always causes small cell lung cancer.
Small cell is the most aggressive form of lung cancer.
It usually starts in the air tubes (bronchi) in the center of the chest.
These tumors can rapidly spread to other parts of the body,
including the brain, liver, and bone.
SMALL CELL LUNG CANCER
- DIFFERNECE
Small cell carcinoma is different from the rest
of histopathological types of lung cancer because
of several biological and clinical features such as:





High speed of proliferation
Short time of duplication of the tumor mass
Early metastases by blood stream
Sensitivity to cytostatic treatment and ionic radiation
Bad outcome of surgical treatment
Considering above mentioned features, lung cancer in clinical practise
is often simply divided into two groups:
 Non-small cell carcinoma ( NSCC)
 Small cell carcinoma (SCC)
LUNG CANCER – RISK FACTORS
CARCINOGENIC FACTORS :
SMOKING !!! ( 60 times higher risk
when smoking > 40 cigarettes a day)
 OCCUPATIONAL RISK FACTORS

NICKEL,
CHROMIUM, ASBESTOS, ARSENIC
HYDROCARBONIC COMPOUNDS
RADIOACTIVE METALS
ENVIORNMENTAL POLLUTION
 TUBERCULOSIS AND CICATRICAL CHANGES OF THE LUNG
 HORMONAL FACTOR ( difference in occurrence in males
and females)
 IMMUNOLOGICAL DEFECTS
 GENETIC FACTORS
( disorders in chromosome 3, K-ras,HER-2/neu,
p53, Rb)

LUNG CANCER – CHARACTER OF
GROWTH
PERIPHERAL CARCINOMA
( often adenoidal carcinoma)
CENTRAL CARCINOMA
( growth in large bronchi)
LUNG CANCER CHARACTER OF
GROWTH
METASTATIC CARCINOMA
( numerous focal changes in both lungs)
SMALL CELL LUNG CANCER
- staging
Limited stage
Cancer is found only in one lung and in nearby lymph nodes. (Lymph
nodes are small, bean-shaped structures that are found throughout the
body. They produce and store infection-fighting cells.)
Extensive stage
Cancer has spread outside of the lung where it began to
other tissues in the chest or to other parts of the body.
Recurrent stage
Recurrent disease means that the cancer has come back (recurred)
after it has been treated. It may come back in the lungs or in another
part of the body.
NON-SMALL CELL LUNG CANCER
TNM STAGING
TNM CLASSIFICATION
T
(tumor feature)
TIS
T1
T2
T3
carcinoma in situ
T4
tumor of any size infiltrating mediastinum, heart, large vessels,
trachea, esophagus, vertebral body, tracheal bifurcation.
tumor up to 3 cm surrounded by the lung tissue
tumor larger than 3 cm, more than 2 cm from tracheal bifurcation.
tumor of any size infiltrating the thoracic wall, diaphragm,
mediastinal pleura. Tumor less than 2 cm from tracheal
bifurcation.
Presence of neoplastic cells in the pleural liquid.
LUNG CANCER – (N feature positive)
N1
LYMPHATIC NODES
OF HIALUS
N2
MEDIASTINAL
LYMPHATIC NODES
N3
LYMPHATIC NODES
OF THE OPPOSITE
SIDE AND
SUPRACLAVICULAR
LUNG CANCER – METASTASES (M feature)
METASTASES OF THE LUNG CANCER:
TOPICAL:
ANATOMICAL
STRUCTURES OF MEDIASTINUM
PLEURA
THORACIC
WALL
REGIONAL LYMPHATIC NODES:
LUNG
HIALUS - N1
MEDIASTINAL - N2
HIALUS OF THE OPPOSITE LUNG – N3
LUNG CANCER – METASTASES (M feature)
VISCERAL METASTASES :
HEPAR
BONES, BONE
MARROW
BRAIN
SUPRARENAL GLANDS
SUBCUTANEOUS
Lung nodes
T1
tumor up to 3cm surrounded by the lung tissue
T2
tumor larger than 3 cm, more than 2 cm from tracheal bifurcation.
T3
tumor of any size infiltrating the thoracic wall, diaphragm,
mediastinal pleura. Tumor less than 2 cm from tracheal bifurcation.
T4
tumor of any size infiltrating mediastinum, heart, large vessels,
trachea, esophagus, vertebral body, tracheal bifurcation.
Presence of neoplastic cells in the pleural liquid.
Stage T4N3
CLINICAL ASSESSMENT OF LUNG
CANCER PROGRESSION
CLINICAL GRADES OF PROGRESSION








Grade 0
Grade IA
Grade IB
Grade IIA
Grade IIB
Tis N0 M0
T1 N0 M0
T2 N0 M0
T1 N1 M0
T2 N1 M0, T3 N0 M0
Grade IIIA
Grade IIIB
Grade IV
T1 N2 M0, T2 N2 M0, T3 N1 M0, T3 N2 M0
every T N3 M0, T4 every N M0
every T, every N, M1
GOOD
RESULTS
OF SURGICAL
TREATMENT
Prognosis
LUNG CANCER DIAGNOSTICS
SUBJECT EXAMINATION
HISTORY:
 FAMILY
OCCERRENCE OF NEOPLASM
 EXPOSITION TO SMOKE FROM CIGARETTES
 OCCUPATIONAL EXPOSURE
LUNG CANCER DIAGNOSTICS
SUBJECT EXAMINATION
SYMPTOMS DEPENDENT ON PRIMARY TUMOR AND
TOPICAL EXPANSION OF NEOPLASM








COUGH (CHANGE OF COUGH IN SMOKERS)
HEMOPTYSIS
DYSPNOEA
PAIN IN THE CHEST
RECURRENT OR LONG-LASTING PNEUMONIA
HOARSENESS
DYSPHAGIA
SHOULDER PAIN
LUNG CANCER DIAGNOSTICS
SUBJECT EXAMINATION
GENERAL SYMPTOMS:





OSTEOARTICULAR PAINS
GENERAL WEAKNESS
LOSS OF BODY MASS
INCREASE IN BODY TEMPERATURE
OTHER SYMPTOMS OF PARANEOPLASTIC
SYNDROMES
LUNG CANCER DIAGNOSTICS
PHYSICAL EXAMINATION (we can identify)










WORSENING OF BRONCHIAL PATENCY
ENLARGEMENT OF LYMPHATIC NODES
PLEURAL EXUDATE
PERICARDIAL EXUDATE
SUPERIOR CAVAL VEIN SYNDROME
HEPAR ENLARGEMENT
THROMBOPHLEBITIS
PAIN IN THE CHEST ON PRESSURE
PARANEOPLASTIC SYNDROMES
OCCUPATION OF CENTRAL OR PERIPHERAL NERVOUS SYSTEM
LUNG CANCER
CLINICAL SUSPICION OF HIGH PROGRESSION
OF LUNG CANCER:
CLINICAL SYMPTOMS:
 hoarseness (palsy of recurrent laryngeal nerve, infiltration
on aortic arch)
 enlargement of supraclavicular lymphatic nodes
( occupation of N3 nodes)
 superior caval vein syndrome ( tumor infiltration or pressure
of packet of enlarged lymphatic nodes on a superior caval
vein)
 neurological symptoms ( metastases in brain)
LUNG CANCER
SUSPICION OF HIGH PROGRESSION OF LUNG
CANCER:
EXAMINATION RESULTS:
 in X-ray – atelectasis of the whole lung
 presence of neoplastic cells in pleural liquid ( T4 feature )
 in bronchoscopy infiltration of tumor < 2 cm from tracheal bifurcation
 shoulder pain ( Pancoast tumor – neoplasm originating from lung apex
infiltrating ribs, subclavicular vessels, shoulder plexus or spine)
 enlargement of the lymphatic nodes of N2 or N3 group in CT
PARANOEPLASTIC SYNDROMES
They are a group of clinical symptoms of the neoplasm resulting from
secretion of substances of different biological effects by the neoplasms
and not connected with direct influence of the tumor or metasteses on
the neighboring tissues. Clinical symptoms manifest in about 50% of patients.


Anorexia-cachexia syndrome (the most frequent)

neuropathies and encephalopathies in patients without metastatic changes in
nervous system, Eaton-Lambert pseudomiasthenic syndrome

Skin changes – so called revelators of the neoplastic disease
( dermatomyositis, lupus erythematosus, acanthosis nigricans, sclerodermia)

Hypercoagulability of blood and wandering thrombophlebitis + other hematological
disorders (anemia, thrombocytopenia)

Ectopic secretion of ACTH syndrome (up to 20% of patients with Cushing
syndrome)

Incorrect secretion of hormones syndromes – antidiuretic hormone (ADH),
parathormone (hiperkalcemia), serotonin (carcinoid syndrome) and others
Hypertrophic pulmonary osteoarthropathy (bilateral edema and osteoarticular pains
of forearms and shanks)
DIAGNOSTICS OF LUNG CANCER
EXAMINATIONS USED TO ASSESSMENT OF PROGRESSION OF
LUNG CANCER:
 SUBJECT AND PHYSICAL EXAMINATION
 CHEST X-RAY
 CHEST COMPUTER TOMOGRAPHY (CT)
 ULTRASOUND EXAMINATION OR CT OF ABDOMEN
 CT OR MR (MAGNETIC RESONANCE) OF BRAIN
 SCYNTYGRAPHY OF BONES
 POSITRON EMISSION TOMOGRAPHY (PET)
CHEST COMPUTER TOMOGRAPHY (CT)
DIAGNOSTICS OF LUNG CANCER
INVASIVE EXAMINATIONS - ASSESSMENT OF
PROGRESSION OF LUNG CANCER :
 BRONCHOFIBEROSCOPY
 TRANSESOPHAGEAL OR TRANSBRONCHIAL
ULTRASOUND EXAMINATION
 MEDIASTINOSCOPY
 MEDIASTINOTOMY
 BIOPSY OF SUPRACLAVICULAR LYMPHATIC NODES
( DANIELS BIOPSY)
 VIDEOTHORACOSCOPY
 DIAGNOSTIC-THERAPEUTIC THORACOTOMY
Mediastinoscopy
Mediastinoscopy is a surgical procedure to examine
the inside of the upper chest between and in front
of the lungs (mediastinum).
During a mediastinoscopy, a small incision is made in the
neck just above the breastbone or on the left side of the
chest next to the breastbone. Then a thin scope
(mediastinoscope) is inserted through the opening.
A tissue sample biopsy can be collected through
the mediastinoscope and then examined under
a microscope for lung problems, such as infection,
inflammation, or cancer.
DIAGNOSTICS OF LUNG CANCER
CLASSICAL RADIOLOGICAL EXAMINATIONS
Changes observed in radiograms:




ROUND SHADOW OF THE LUNG
CHANGE OF OUTLINE OF HILUS AND/OR MEDIASTINUM
LOCAL DISORDERS IN AIRITY OF LUNG TISSUE
INFILTRATION CHANGES OF LUNG TISSUE
COMPUTER TOMOGRAPHY
Possibilities of examination:

Assessment of location, size and consistency of the tumor

Assessment of the neighboring lung tissue

Primary assessment of mediastinal lymphatic nodes

Assessment of occupation of neighboring organs
( thoracic wall, large vessels, esophagus, diaphragm, pericardium)
DIAGNOSTICS OF LUNG CANCER
PRIMARY TUMOR ASSESSMENT:
 ENDOSCOPY OF THE BRONCHIAL TREE
(location of tumor, distance from carina, state of lymphatic
nodes of bifurcation, possibility of taking biopsy specimens to
histopathological examination)
 RADIOLOGICAL EXAMINATIONS ( classical X-ray, CT,
NMR)
 CYTOLOGICAL EXAMINATION OF LIQUID FROM
PLEURAL OR PERICARDIAL CAVITY ( positive result
treated as T4 feature)
DIAGNOSTICS OF LUNG CANCER
ASSESSMENT OF REGIONAL LYMPHATIC NODES :
 ENDOSCOPY OF BRONCHIAL TREE
(BAC OF TRACHEAL BIFURCATION LYMPHATIC NODES)
 RADIOLOGICAL EXAMINATIONS (CT, spiral CT, NMR)
 MEDIASTINOSCOPY (NODES OF GROUP II, IV, VII)
 PARASTERNAL MEDIASTINOTOMY
(NODES OF GROUP V i VI ON THE LEFT)
 TRANSESOPHAGEAL OR TRANSBRONCHIAL ULTRASOUND
EXAMINATION
 DANIELS BIOPSY of suprasternal lymphatic nodes
 VIDEOTHORACOSCOPY
DIAGNOSTICS OF LUNG CANCER
ASSESSMENT OF ORGAN METASTASES :
 ULTRASOUND EXAMINATION OR CT OF ABDOMEN
 THIN-NEEDLE ASPIRATION BIOPSY of suspicious isolated tumor in
suprarenal gland
 CT or NMR of brain
 PET – positron emission tomography
 SCYNTYGRAPHY OF OSSEOUS SYSTEM
(routine in microcellular carcinoma in planned combined treatment, in
non-microcellular carcinoma in case of suspicion of metastases in
bones)
 BILATERAL TREPANOBIOPSY OF BONE MARROW FROM ILIAC ALA
(in microcellular carcinoma in planned combined treatment)
 SURGICAL BIOPSY of changes suspected of metastases to
subcutaneous tissue
DIAGNOSTICS OF LUNG CANCER
METHODS OF ESTABLISHMENT OF HISTOPATHOLOGICAL TYPE
 CYTOLOGICAL EXAMINATION OF SPUTUM
 CYTOLOGICAL OR HISTOPATHOLOGICAL EXAMINATION OF MATERIAL
COLLECTED IN BRONCHOFIBEROSCOPY
 CYTOLOGICAL EXAMINATION OF PLEURAL EXUDATE
 THIN-NEEDLE ASPIRATION BIOPSY of peripheral lung tumor ( transthoracal
thin-needle aspiration biopsy – puncture through thoracic wall under control of
ultrasound or CT)
 THIN-NEEDLE ASPIRATION BIOPSY OF PERIPHERAL LYMPHATIC NODES
 HISTOPATHOLOGICAL EXAMINATION OF MATERIAL FROM
MEDIASTINOSCOPY, MEDIASTINOTOMY OR VIDEOTHORACOSCOPY
 DIAGNOSTIC THORACOTOMY
TREATMENT OF SMALL CELL LUNG CANCER
The basic therapy of this type of lung cancer is chemotherapy, which expands the lenght
of life, alleviates the symptoms and reduces the mass of tumor. Usually due to resistance
to medicines remission period after chemotherapy is less than a year.
The lack of standardized and commonly accepted scheme of treatment.
The most often cisplatin combined with etoposide.
LD type
(limited to one half of the chest)
SIMULTANEOUS RADIO-CHEMOTHERAPY (IF THERE IS NO NEOPLASTIC EXUDATE)
X-RAY-therapy:
According to Turrisi’s scheme – 2 doses daily 1,5 Gy with 6 h break.
Total dose 45 Gy in 3 weeks
Chemotherapy – 4 cycles lasting 3 days repeated every 3 weeks
According to Arriagda’s scheme – alternating chemo radiotherapy, where radiation is applied between
2/3, 3 /4 and 4/5 cycle of chemotherapy.
Total radiation dose 55 Gy, altogether 6 cycles of chemotherapy,
7-day breaks
ED type
(diffuse – the illness expands on the other side of the thorax, mediastinum
and supraclavicular nodes)
SYSTEMIC, MULTITHERAPEUTIC CHEMOTHERAPY
Sometimes preservative radiation of skull, which delays brain metastases in patients with LD type.
TREATMENT OF NON-MICROCELLULAR LUNG
CANCER
I GRADE: IA (T1N0M0), IB ( T2N0M0)
The treatment of choice is surgical resection. Preferably lobectomy , cancer exceeding main
Fissure require pneumonectomy.
T2 tumors from lobal bronchus or infiltrating main bronchus require sleeve lobectomy
or pneumonectomy.
After resection of tumor T1N0M0 5-year survival is estimated to 65-70%, T2N0M0- 45-55% .
Perioperative death rate about 3%-4%.
In patients disqualified from surgical treatment – radiotherapy recommended.
II GRADE: IIA (T1N1M0), IIB ( T2N1M0, T3N0M0)
Indicated surgical treatment even with metastases in N1 nodes.
Usually anatomical resection of the lung + resection of infiltration on the thoracic
wall + lymphadenectomy.
Due to frequent local recurrences and visceral metastases additional treatment is recommended;
X-ray therapy decreases the frequency of topical and mediastinal recurrences, chemotherapy
reduces systemic recurrences. However, no strategy increases total life length.
After resection of tumor T1N1M0 5-year survival is estimated to 45-55%, in T2N1M0- 35%-50%.
In T3N0M0 tumors about 30%-35%. This group involves tumors of lung apex ( Pancoasta),
in which the prognosis is the worst. Preoperative X-ray therapy reduces the mass of the tumor
and increases the ability of resection of Pancoast tumors. Preoperative chemotherapy is examined.
Only 20% of patients is in I and II grade of progression at the time of diagnosis.
TREATMENT OF NON-MICROCELLULAR LUNG
CANCER
GRADE III: III A AND III B
Topical and systemic treatment considered due to large risk of topical recurrence
and metastases. Exact selection of patients to surgical treatment necessary.
In case of T3 tumors in order to resect the tumor totally it is necessary to apply
pneumonectomy.
It is possible in patients with appropriate respiratory reserve.
Patients in III grade of progression of lung cancer are about 20%
Often it is technically possible to perform resection but long-term results are much worse
(N2 feature – topical recurrences in mediastinum).
In chosen T4 tumors limited to tracheal bifurcation resection of bifurcation with lobectomy
or pneumonectomy ,,sleeve” type is performed. However in 50% of patients mediastinal
nodes are occupied.
Some surgeon apply preoperative chemotherapy, application of radiotherapy is limited
due to the lack of possibilities of controlled embracement of the tumor and the occupied
nodes with the radiation dose.
5-year survival after surgical treatment on this grade of progression is estimated to 13 - 25% .
TREATMENT OF THE LUNG
CANCER
In Poland in 2005 - 3518 patients
underwent primary surgical treatment
because of non-microcellular cancer.
Perioperative death rate was 2,53%.
CRITERIA OF QUALIFICATION OF PATIENTS TO SURGICAL
TREATMENT :
 CONFIRMATION IN PREOPERATIVE EXAMINATION
NON-MICROCELLULAR LUNG CANCER
 TOPICAL OPERATIVITY OF LUNG CANCER (T1-T3 FEATURE)
 NOT OCCUPIED LYMPHATIC NODES OF N2 AND N3 GROUP
(procedure possible in case of occupation of N2 nodes – after
successful preoperative chemotherapy and after confirmed in
repeated mediastinoscopy lack of neo cells in collected N2
nodes)
 GENERAL PATIENT’S STATE ENABLING THORACOTOMY
 ASSESSMENT OF PREDICTED STATE OF RESPIRATORY EFFICIENCY
AFTER A LARGE ANATOMICAL RESECTION OF THE LUNG
(pneumonectomy, lobectomy) on the basis of spirometric tests,
ventilation or perfusion scintigraphy and DLCO
(Diffusing capacity of the lung for carbon monoxide)
ASSESSMENT SCALE OF PATIENT’S EFFICIENCY ACCORDING
TO ZUBROD (ECCOG- WHO)
O – normal effectiveness, ability of performing all activities with
no restrictions
1 – clinical symptoms, patient able to walk and do a light job
2 – patient able to perform every day activities but not able to work;
spends less than a half of day in bed
3 – patient able to perform every day routines in a restricted way;
spends more than a half of day in bed
4 – patient unable to move in bed; requires constant care
The best candidates to resection of the lung tissue are patients in O and 1 grade
of the scale, much worse results in patients in the 2 grade
LUNG CANCER TREATMENT
KINDS OF SURGICAL PROCEDURES APPLIED
IN LUNG CANCER TREATMENT
ANATOMICAL RESECTIONS :




LUNG RESECTION (pneumonectomy)
RESECTION OF LUNG LOBE (lobectomY)
RESECTION OF TWO LOBES OF THE RIGHT LUNG (bilobectomy)
RESECTION OF 1 OR 2 LUNG SEGMENTS (segmentectomy,
bisegmentectomy) – non-radical procedure rarely used
 SLEEVE RESECTION LOBECTOMY
 BROADENED ANATOMICAL RESECTIONS – EXCISION OF THE PART OF
THE THORACIC WALL ( ribs, intercostal spaces, diaphragm, pericardium)
 LYMPHADENECTOMY – removal of local lymphatic nodes
NON-ANATOMICAL RESECTIONS: rarely performed, indicated in chosen
cases of patients in poor general conditions and little respiratory reserves
 MARGINAL RESECTION
 WEDGE RESECTION
Lung
Resection
Wedge Excision
 Segmentectomy
 Lobectomy
 Bilobectomy
 Pneumonectomy

SLEEVE RESECTION LOBECTOMY
Procedure performed in chosen cases of benign tumors or malignant tumors of the
lowest progression grade (T1N0) located in the opening of the upper-lobe bronchus
of the right lung. Such tumor location is an indication to pneumonectomy.
The procedure involves excision of the upper lobe of the right lung with a part of the
main and medial bronchus and then implanting medial bronchus
to the main one, which gives the possibility of saving medial and lower lobe.
Sleeve resection of the upper lobe
Removal of benign tumor of medial
bronchus in bronchoplasty
TREATMENT OF LUNG CANCER
CHEMOTHERAPY IN TREATMENT OF NONMICROCELLULAR LUNG CANCER
 NEOADJUWANT CHEMOTHERAPY

INDUCTIVE CHEMIOTERAPY SUPPLEMENTING
TOPICAL TREATMENT (adjuwant therapy)

COMBINED CHEMOTHERAPY WITH RADIOTHERAPY

PALLIATIVE CHEMOTHERAPY
TREATMENT OF LUNG CANCER
RADIOTHERAPY IN TREATMENT OF NONMICROCELLULAR LUNG CANCER
USED IN NON-SURGICAL TREATMENT OF EARLY GRADES
OF CANCER AS A MONOTHERAPY AS WELL AS A PART
OF COMBINED THERAPY IN TOPICALLY ADVANCED
NEOPLASTIC DISEASES.
IT IS EFFECTIVE IN PALLIATIVE TREATMENT
AND TREATMENT OF DISTANT METASTASES.
ITS INFLUENCE ON LENGHTENING OF SURVIVAL TIME
IS SIMILARLY TO CHEMOTHERAPY LITTLE.
TREATMENT OF LUNG CANCER
INDUCTIVE CHEMOTHERAPY
USED IN PATIENTS IN IIIA STAGE WITH N2 FEATURE
(T1-3, N2, M0), IN WHICH THERE ARE TECHNICAL
POSSIBILITIES OF PERFORMING TOTAL SURGICAL
TREATMENT

1-3 COURSES (cisplatin, winorelbin, winblastin, windezin, wepeside,
gemcytabin)

CONTROL OF RESPONSE

SURGICAL TREATMENT 21 DAYS AFTER THE LAST COURSE

SUPPLEMENTARY RADIOTHERAPY (confirmation of metastases to N2
nodes or positive margin in the stump of removed bronchus in
histopathological examination)
TREATMENT OF LUNG CANCER
CHEMOTHERAPY COMBINED WITH RADIOTHERAPY
USED IN PATIENTS IN III B GRADE (T4, every N, M0 and
every T, N3, M) and in patients in lower grades of
progression who cannot undergo surgical treatment
because of health state


CHEMOTHERAPY - 1-2 courses before radiotherapy
RADIOTHERAPY - 1,8-2,0 Gy daily;
total dose =60-65Gy.
The field involves primary tumor and hilar lymphatic
nodes and bilaterally mediastinal ones.
TREATMENT OF LUNG CANCER
CONTRAINDICATIONS TO RADIOTHERAPY

STAGE OF GENERAL EFFICIENCY WORSE THAN 2

PRESENCE OF PLEURAL EXUDATE

PRESENCE OF ACTIVE INFECTION

LOSS IN BODY WEIGTH MORE THAN 10% IN 3 MONTHS BEFORE
TREATMENT
TREATMENT OF LUNG CANCER IN IV GRADE OF
PROGRESSION
PALLIATIVE CHEMOTHERAPY
INDICATED IN SOME PATIENTS IN IV GRADE (M1),
WHO FULFILL THE FOLLOWING CONDITIONS:

GOOD GENERAL STATE

LITTLE LOSS IN BODY WEIGTH

POSSIBILITY OF CONTROL THE RESPONSE AFTER 2 CYCLES

LACK OF ACTIVE INFECTION

PRESERVED EFFICIENCY OF ORGANS AND SYSTEMS

PATIENT DISQUALIFIED FROM PALLIATIVE RADIOTHERAPY