Surgical, radiotherapic, chemotherapy & laser therapy involved in Bronchial Carcinoma Treatment

Unlike some other cancers, there has been no improvement in survival from carcinoma of the bronchus apart from small cell cancer.

Only 20 percent of the patients are alive 1 year after diagnosis and only 6-8 percent after 5 years (cf. 50% for breast or cervix).

Surgery:

The only treatment of any value for non-small cell cancer of the lung is surgery. Only 20 percent of all cases are suitable for resection and only 25 –30 percent survive for 6 years.

The mortality of thoracotomy in patients over 65 years with metastatic disease exceeds the expected 5-year survival rate and should therefore be avoided.

Preoperative Assessment:

Radionuclide scanning for detection of metastatic disease in liver and bone is rarely positive in the absence of symptoms or abnormal enzyme tests (serum alkaline phophatase) and is therefore unnecessary.

A normal chest CT scan indicates no mediastinal spread of the tumour and favors curative resection. Because of their common aetiology, chronic bronchitis and emphysema are frequently present.

An FEV of less than 1.5 liters is not compatible with an active life following Pneumonectomy, although the surgery itself can be successfully accomplished. This also applies when the gas transfer test is reduced by 50 percent.

Radiation therapy for Cure:

High dose radiotherapy (6500 rad; 65 Gy) can produce results that are as good as those of surgery in patients who are fit and who have slowly growing squamous carcinoma.

It is the treatment of choice if the tumour is inoperable for reasons such as poor lung function. Radiation pneumonitis (defined as an acute infiltrate precisely confided to the radiation area and occurring.

w within 3 months of radiotherapy) develops in 10 –15 percent. Radiation fibrosis, a fibrotic change occurring within 1 year or so of radiotherapy and not precisely confined to the radiation area, occurs to some degree in all cases. These complications are usually of little importance.

Symptomatic radiation treatment:

Bone pain, haemoptysis and the superior vena cava syndrome respond favorably to irradiation in the short term.

Chemotherapy:

This is not effective for the treatment of non-small cell cancer of the lung. In small cell cancer, single or combination chemotherapy has resulted in a five-fold increase in median survival from 2 – 10 months.

A small number of patients enjoy several years of remission. Good results have been achieved with the combination of mitomycin, ifosfamide and cisplatin.

The unwanted effects are greater than with single agent chemotherapy with etoposide alone, which should be reserved for elderly patients and those with additional medical or physical disabilities.

Laser therapy, endobronchial irradiation and tracheobronchial stents:

This is used in the palliation of inoperable lung cancer. The techniques are complementary and considerable skill is required both in deciding which single or combination of therapies is required and in their execution.

Tracheobronchial narrowing from intraluminal tumour or extrinsic compression causes diabling breathlessness, intractable cough and complications which may lead to death including infection, haemoptysis and respiratory failure.

A neodymium Yag (Nd-Yag) laser passed through a fibreoptic bronchoscope can be used to vaporize inoperable fungating intraluminal carcinoma involving short segments of trachea or main bronchus.

Benign tumors, strictures and vascular lesions can also be effectively treated with immediate relief of symptoms. Endobronchial irradiation (brachytherapy) is useful for the treatment of both intraluminal tumour and malignant extrinsic compression.

A radioactive source is after loaded into a catheter placed adjacent to the carcinoma under fibreoptic bronchoscope control. Radiation dose falls rapidly with distance from the source minimizing damage to adjacent normal tissue.

Reduction in endoscopically assessed tumour size occurs in 70-90 percent of cases. Tracheobronchial stents made of silicone or as expandable metal springs are now available for insertion into strictures caused by tumour or from external compression or when there is weakening and collapse of the trachebronchial wall.

 

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