Chemotherapy and radiotherapy are the keys of current management of SCLC. For many years, the diagnosis of small cell lung cancer has been considered a contraindication to surgery because radiotherapy was at least equivalent in terms of local control and the rate of resectability of SCLC patients was poor. The role of surgery has been defined by evidence accumulated in the last 30 years but conclusions are limited by the fact that the most important studies are dated and conducted when the main staging tool was exploratory thoracotomy. The rationale for surgery in the context of SCLC is based on 3 factors: 1) Several historical series on patients operated for limited SCLC reported some long term survivors, showing that permanent cure can be achieved. For this reason, it is now accepted that for the rare patients with very limited stage disease (T1-T2 tumors) surgical resection followed by platinum-based chemotherapy could be offered. 2) After chemotherapy and radiotherapy, the rate of local relapse is 20-30%. The assumption that surgery might be superior to radiotherapy in local control of limited SCLC has been suggested but not still proved. 3) Surgery can precisely assess pathological response to chemotherapy, identify carcinoids erroneously diagnosed as SCLC, treat the NSCLC component of tumors with a mixed histology. In the case of planned surgery, preoperative investigations should be completed by MRI of the brain, mediastinoscopy (to rule out subclinical N2/N3 patients) and probably PET scan. Even if some controversies exist, it is accepted that surgery can be proposed as the first treatment in patents with T1-T2 lesions without sign of lymph nodes involvement, followed by adjuvant chemotherapy. Surgery in stage II and III must be planned on a multidisciplinary basis, in the context of controlled clinical trials.
Attention to palliation is imperative in the management of patients with lung cancer, given the burden of symptoms and the incurable nature of the illness in a large proportion of patients. Focus on symptom control and enhancing quality of life can and should coexist with active treatment of the cancer process and attempts at prolongation of life. This article reviews some of the methodological issues in assessing palliation, and presents the evidence for the role of various therapeutic modalities in palliation of thoracic symptoms, including external beam radiotherapy, brachytherapy, chemotherapy, photodynamic therapy, and vascular stents. Palliation of metastatic disease, particularly bone and brain metastases, is also reviewed.
The majority of patients with non-small cell lung cancer have locally advanced and metastatic disease at diagnosis. Combination platinum-based chemotherapy is the standard treatment for patients with advanced disease who have a performance status of 0-1. Chemotherapy is superior to supportive care alone in terms of survival, palliation of symptoms, and in many studies, improving quality of life. Newer third generation therapies such as paclitaxel, docetaxel, vinorelbine, and gemcitabine have been proven effective as single agents with minimal toxicity, compared with supportive care alone. In combination with platinum, these agents produce higher response rates than older platinum-based regimens, are associated with additional survival benefits, and are generally more convenient and less toxic for patients. Newer nonplatinum doublets appear equivalent to newer platinum-regimens and have expanded the options available for patients. Targeted agents are promising and may soon offer patients more effective and less toxic therapies. Progress in treatment in the advanced setting has led to advances in the care of locally advanced disease. Combination chemoradiotherapy is a standard treatment for locally advanced disease, and studies with newer agents are in progress.
Seminars in Surgical OncologyVolume 21, Issue 4 p. 221-222 Foreword: Chemoradiation for GI cancers Tyvin A. Rich MD, Corresponding Author Tyvin A. Rich MD Guest Editor TAR4D@hscmail.mcc.virginia.edu Charlottesville, VirginiaDepartment of Radiation Oncology, Box 800383, University of Virginia Health System, Charlottesville, Virginia 22908.Search for more papers by this author Tyvin A. Rich MD, Corresponding Author Tyvin A. Rich MD Guest Editor TAR4D@hscmail.mcc.virginia.edu Charlottesville, VirginiaDepartment of Radiation Oncology, Box 800383, University of Virginia Health System, Charlottesville, Virginia 22908.Search for more papers by this author First published: 19 November 2003 https://doi.org/10.1002/ssu.10047AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume21, Issue4November 2003Pages 221-222 RelatedInformation
Seminars in Surgical OncologyVolume 21, Issue 1 p. 1-2 Foreword: TNM sixth edition: New developments† Leslie H. Sobin MD, Corresponding Author Leslie H. Sobin MD Department of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DCDepartment of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DCSearch for more papers by this author Leslie H. Sobin MD, Corresponding Author Leslie H. Sobin MD Department of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DCDepartment of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DCSearch for more papers by this author First published: 11 August 2003 https://doi.org/10.1002/ssu.10013 † This article is a U.S. Government work and, as such, is in the public domain in the United States of America. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume21, Issue12003Pages 1-2 RelatedInformation
