Skip to main content Accessibility help
×
Home
Hostname: page-component-6c8bd87754-hvdfp Total loading time: 0.437 Render date: 2022-01-19T19:52:02.481Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Book contents

31 - Management of cancer of the lung

Published online by Cambridge University Press:  05 November 2015

Alison Brewster
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Fergus MacBeth
Affiliation:
Cardiff University, Cardiff, UK
Louise Hanna
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Get access

Summary

Introduction

Lung cancer has a significant impact on mortality in the UK, accounting for 6% of all deaths and 22% of deaths from cancer. It has one of the lowest survival outcomes of any cancer, with a 5-year survival of 7% in men and 9% in women which has changed little over the past 30 years. The last 10 years has seen a significant improvement in one-year survival, probably due to more widespread use of palliative therapies. One-year survival in the period 1990–1991 was 20.4% for men and women compared with 30.4% for men and 35.1% for women in the period 2010–2011 (http://www.cancerresearchuk.org/, accessed January 2015).

The lung cancer pathway is complex. Up to 38% of patients present as an acute medical admission compared to 23% of cancer presentations overall and this is known to be associated with a poorer outcome. Non-acute patients are assessed in rapid access clinics by chest physicians following a diagnostic CT scan. Informed of the high suspicion of lung cancer, they then undergo a series of tests to stage, establish histology and assess fitness. Specialist nurses play a key role in supporting the patient and their carers while they wait to discuss treatment options. The mean rate for surgery in England and Wales is 21.9% (range 15.1–30.8%) and for Scotland, 20.5% (Health and Social Care Information Centre, 2013). For those unfit or unwilling to undergo surgery, radiotherapy offers a possibility of cure, and high local control rates are now reported with stereotactic ablative radiotherapy (SABR) (Takeda et al., 2013). Adjuvant chemotherapy can increase absolute survival rates by up to 4%, but with 70% of patients presenting with stage IIIB and IV disease, most patients are offered palliative interventions. Chemotherapy can improve symptom control, in particular systemic symptoms, and offer modest improvements in median survival. Palliative radiotherapy is highly effective in improving symptoms such as cough, haemoptysis and pain. More recently, targeted therapies such as gefitinib offer improvements in median survival for those with EGFR mutations, and as more molecular targets are identified, there is optimism that survival outcomes in lung cancer, which has lagged far behind other malignancies such as breast cancer, may start to improve.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aberle, D., Adams, A., Berg, C., et al. (2011). Reduced lung-cancer mortality with low dose computed tomographic screening. N. Engl. J. Med., 365, 395–409.Google ScholarPubMed
Arriagada, R., Pignon, J. P., Laplanche, A., et al. (1997). Prophylactic cranial irradiation for small-cell lung cancer. Lancet, 349, 138.CrossRefGoogle ScholarPubMed
Arriagada, R., Bergman, B., Dunant, A., et al. (2004). Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N. Engl. J. Med., 350, 351–360.Google ScholarPubMed
Aupérin, A., Le Péchoux, C., Rolland, E., et al. (2010). Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced NSCLC.J. Clin. Oncol., 28, 2181–2190.CrossRefGoogle Scholar
de Ruysscher, D., Pijls-Johannesma, M., Vansteenkiste, J., et al. (2006). Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer. Ann. Oncol., 17, 543–552.CrossRefGoogle ScholarPubMed
Falk, S. J., Girling, D. J., White, R. J., et al. (2002). Immediate versus delayed palliative thoracic radiotherapy in patients with unresectable locally advanced non-small cell lung cancer and minimal thoracic symptoms: randomised controlled trial. Br. Med. J., 325, 465–472.CrossRefGoogle ScholarPubMed
Ferry, D., Billingham, L., Jarrett, H. W., et al. (2011). S85 British Thoracic Oncology Group trial, BTOG2: Randomised phase III clinical trial of gemcitabine combined with cisplatin 50mg/m2 (GC50) vs cisplatin 80mg/m2 (GC80) vs carboplatin AUC 6 (GCB6) in advanced NSCLC.Thorax, 66, A41 S85.CrossRefGoogle Scholar
Gilligan, D., Nicolson, M., Smith, I., et al. (2007). Pre-operative chemotherapy in patients with resectable NSCLC: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet, 369, 1929–1937.CrossRefGoogle Scholar
Goldstraw, P., Crowley, J., Chansky, K., et al. (2007). The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage grouping in the forthcoming (seventh) edition of the TNM Classification of Malignant Tumours. J. Thoracic Oncol., 2, 706–714.CrossRefGoogle Scholar
Graham, M. V., Purdy, J. A., Emami, B., et al. (1999). Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non small cell lung cancer (NSCLC). Int. J. Radiat. Oncol. Biol. Phys., 45, 323–329.CrossRefGoogle Scholar
Health and Social Care Information Centre. (2013). National Lung Cancer Audit Report 2013. Report for the audit period 2012.Leeds: Health and Social Care Information Centre, available at: http://www.hscic.gov.uk/catalogue/PUB12719/clin-audi-supp-prog-lung-nlca-2013-rep.pdf (accessed October 2014).
ICRU. (1999). Prescribing, Recording and Reporting Photon Beam Therapy (Report 62): Supplement to ICRU Report 50.Bethesda, MD: International Commission on Radiation Units and Measurements.
Macbeth, F. R., Bolger, J. J., Hopwood, P., et al. (1996). Randomised trial of palliative two-fraction versus more intensive thirteen fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Clin. Oncol., 8, 167–175.CrossRefGoogle Scholar
Maguire, J., Khan, I., McNenimin, R., et al. (2014) SOCCAR: A randomised phase II trial comparing concurrent chemotherapy and radical hypofractionated radiotherapy in patients with inoperable stage III non-small cell lung cancer and good performance status. Eur. J. Cancer, 50, 2939–49.CrossRefGoogle ScholarPubMed
Manser, R., Wright, G., Hart, D., et al. (2005). Surgery for early stage non small cell lung cancer. Cochrane Database Syst Rev., (1) CD004699.Google ScholarPubMed
Masaoka, A., Monden, Y., Nakahara, K., et al. (1981). Follow-up study of thymomas with special reference to their clinical stages. Cancer, 48, 2485–2492.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Medical Research Council Lung Cancer Working Party. (1992). A Medical Research Council (MRC) randomised trial of palliative radiotherapy with two fractions or a single fraction in patients with inoperable non-small-cell lung cancer (NSCLC) and poor performance status. Br. J. Cancer, 65, 934–941.
NICE. (2008). TA162. Erlotinib for the Treatment of Non-Small-Cell Lung Cancer. National Institute for Health and Care Excellence, available at: http://www.nice.org.uk/guidance/ta162 (accessed October 2014).
NICE. (2010). TA190. Pemetrexed for the Maintenance Treatment of Non-Small-Cell Lung Cancer. National Institute for Health and Care Excellence, available at: http://www.nice.org.uk/guidance/ta190 (accessed October 2014).
NICE. (2011a). TA227. Erlotinib Monotherapy for Maintenance Treatment of Non-Small-Cell Lung Cancer. National Institute for Health and Care Excellence, available at: http://www.nice.org.uk/guidance/ta227 (accessed October 2014).
NICE. (2011b). CG121. Lung Cancer: The Diagnosis and Treatment of Lung Cancer. National Institute for Health and Care Excellence, available at: http://www.nice.org.uk/guidance/CG121 (accessed October 2014).
NICE. (2013). TA296. Crizotinib for Previously Treated Non-Small-Cell Lung Cancer Associated with an Anaplastic Lymphoma Kinase Fusion Gene. National Institute for Health and Care Excellence, available at: http://www.nice.org.uk/guidance/ta296 (accessed October 2014).
NICE. (2015). TA347. Nintedanib for previously treated locally advanced recurrent non small cell lung cancer. National Institute for Health and Care Excellence, available at: www.nice.org.uk/guidance/ta347 (accessed August 2015).
Non Small Cell Lung Cancer Collaborative Group. (1995). Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Br. Med. J., 311, 899–909.
Paz-Ares, L.G, de Marinis, F., Dediu, M., et al. (2013). Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non small cell lung cancer. J. Clin. Oncol., 10, 2895–2902.Google Scholar
Pignon, J. P., Tribodet, G. V., Scagliotti, J., et al. (2008). Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J. Clin. Oncol., 26 3552–9.CrossRefGoogle ScholarPubMed
PORT Meta-analysis Trialists Group. (1998). Postoperative radiotherapy in non-small cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. Lancet, 352, 257–263.
Rudd, R. M., Gower, N. H., Spiro, S. G., et al. (2005). Gemcitabine plus carboplatin versus mitomycin, ifosfamide and cisplatin in patients with stage IIIB or IV non-small cell lung cancer: a phase III randomised study of the London Lung Cancer GroupJ. Clin. Oncol., 23, 142–153.CrossRefGoogle ScholarPubMed
Rusch, V. W., Asamura, H., Watanabe, H., et al. (2009). The IASLC Lung Cancer Staging Project. A proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J. Thoracic Oncol., 4, 568–577.CrossRefGoogle ScholarPubMed
Saunders, M., Dische, S., Barrett, A., et al. (1999). Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. Radiother. Oncol., 52, 137–148.CrossRefGoogle ScholarPubMed
Scagliotti, G., Parikh, P., von Pawel, J., et al. (2008). Phase III study comparing cisplatin plus gemcitabine with cisplatin and pemtrexed in chemotherapy-naive patients with advanced stage non small cell lung cancer. J. Clin. Oncol., 26, 3543–3551.CrossRefGoogle Scholar
Senthi, S., Lagerwaard, F. J., Haasbeek, C. J. A., et al. (2012). Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: a retrospective analysis. Lancet Oncol., 13, 802–809.CrossRefGoogle ScholarPubMed
Slotman, B., Favre-Finn, C.,Kramer, G., et al. (2007). Prophylatic cranial radiotherapy in extensive small-cell lung cancer. N. Engl. J. Med., 357, 664–672.CrossRefGoogle Scholar
Slotman, B., von Tinteren, H., Pragg, O. G., et al. (2014). The use of thoracic radiotherapy for extensive stage small cell lung cancer – a phase 3 randomised controlled trial. Lancet published on line. http://dx.doi.org/10.1016/so140-6737(14)6105-0CrossRef
Spiro, S. G., Rudd, R. M., Souhami, R. L., et al. (2004). Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life. Thorax, 59, 828–836.CrossRefGoogle ScholarPubMed
Stout, R., Barber, P. V., Burt, P. A., et al. (2000). Clinical and quality of life outcomes in the first United Kingdom randomised trial of endobronchial brachytherapy (intraluminal therapy) vs. external beam radiotherapy in the palliative treatment of inoperable non-small cell lung cancer. Radiother. Oncol., 56, 323–327.CrossRefGoogle Scholar
Takeda, A., Sanuki, N., Eriguchi, T., et al. (2013). Stereoablative body radiotherapy for octogenarians with non small cell lung cancer. Int. J. Radiat. Oncol. Biol. Phys., 86, 257–263.CrossRefGoogle Scholar
Thatcher, N., Qian, W., Clark, P., et al. (2005). Ifosfamide, carboplatin and etoposide with midcycle vincristine versus standard chemotherapy in patients with small cell lung cancer and good performance status: clinical and quality of life results of the British Medical Research Council multicentre randomized LU21 trial. J. Clin. Oncol., 23, 8371–8379.CrossRefGoogle Scholar
Travis, L. (2011). Pathology of lung cancer. Clin. Chest Med., 32, 669–692.CrossRefGoogle ScholarPubMed
Travis, W. D., Brambilla, E., Noguchi, M., et al. (2004). International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory/Society international multidisciplinary classification of lung adenocarcinoma. J. Thorac. Oncol., 6, 244–285.Google Scholar
Turrisi, A. T. 3rd, Kim, K., Blum, R., et al. (1999). Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N. Engl. J. Med., 340, 265–271.CrossRefGoogle ScholarPubMed
UICC. (2009). TNM classification of malignant tumours (7th edition), ed. Sobin, L. H., Gospodarowitc, M. K. and Wittekind, Ch. Oxford: Wiley-Blackwell, pp 138–146.
UK Consortium. (2014). Stereotactic Ablative Body Radiation Therapy (SABR): A Resource. SABR UK Consortium. v 4.1. Available at http://www.actionradiotherapy.org/ (accessed October 2014).
Yokoi, K., Kamiya, N., Matsuguma, H., et al. (1999). Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI.Chest, 115, 714–719.CrossRefGoogle ScholarPubMed
Zhao, Y., Xie, X., deKonig, H., et al. (2011). NELSON lung screening study. Cancer Imag., 11(1A), S79–84.Google Scholar

Send book to Kindle

To send this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats
×