In small cell lung cancer, combination chemotherapy including agents such as etoposide, teniposide, cisplatin, doxorubicin, vincristine and cyclophosphamide continues to be the backbone of therapy. Epipodophyllotoxin derivatives, together with cisplatin, are used increasingly as part of the initial therapy. Complete plus partial responses to combination chemotherapy still occur in 80-90% of all patients with a median duration of 9-11 months. Median survival in these studies is at present 11-16 months depending on the initial tumour stage. Deaths from small cell lung cancer continue to occur until 7 years after diagnosis, but rarely thereafter. At this point, overall survival is around 5% and include a small fraction of patients (1%) initially presenting with extensive disease. The optimum duration of treatment is still uncertain. For patients with extensive disease, the use of alternating chemotherapy has been shown in a couple of randomized studies to yield the best results, as judged by long-term survival. The results of several phase II studies stress the importance of dose scheduling of etoposide in small cell lung cancer, with continuous treatment of 5 days' duration or more being superior. The therapeutic results for epidermoid, adenoid, large cell carcinoma and mesothelioma are essentially unchanged. The treatment of patients with these types of lung cancer should continue to be considered experimental, since no standard chemotherapy has as yet been developed, neither when given as single modality nor in combination with surgery or radiotherapy. One single study comparing induction chemotherapy before irradiation vs irradiation alone has resulted in an improvement of median survival of 4 months and doubled the number of long-term survivors. Since three-fourths of the patients with locoregional disease will die within 3 years, further improvements in both systemic and local treatment are needed.
This chapter covers the management of non-small cell lung cancer, small cell lung cancer, and mesothelioma. It covers the epidemiology and aetiology of each specific cancer. Common presenting signs and symptoms are described, as well as the normal investigative pathway. Management of the different stages of non-small cell and small cell lung cancer are covered, including surgery, chemotherapy, and radiotherapy, and for non-small cell lung cancer the targeted therapies. The section on mesothelioma looks at the aetiology, in particular the occupational and environmental aspect, including issues surrounding compensation and notification. Management of the disease includes surgery, chemotherapy, and radiotherapy. Nursing management issues that are covered include supporting patients with poor-prognosis disease and the complex psychosocial issues of this diagnosis.
Radiation Medicine Rounds is intended to serve as both a reference and instructional tool for students, housestaff, fellows, practicing clinicians, medical physicists, cancer biologists, radiobiologists, and interdisciplinary colleagues throughout the oncology spectrum. This issue of Radiation Medicine Rounds discusses the more salient topics surrounding the role of radiation therapy in breast cancer. The specialty of radiation therapy has increased in complexity over the years, yet as technology improves, the goal of improving outcomes while decreasing toxicity remains critical.
