I will discuss two Non Small lung cancer (NSCLC)cases and the evidences used to decide the patients’ management.
Case 1:
A 60-year-old man with history of breathlessness and cough. Lung function revealed FEV1 1.60, TLCO (60% predicted) and patient’s performance status was 1. Subsequently, he had staging CT scan/PET scan/EBUS and all the investigations revealed the final diagnosis stage IIIA T3N2(sub carinal lymph nodes metastasis) M0 Non small cell lung cancer squamous (NSCLC). The patient’s case was discussed at the lung MDT, decision was for concurrent chemoradiotherapy (CRT).
I will be discussing the evidence for using concurrent chemoradiotherapy (CRT) in stage III NSCLC comparing to sequential chemoradiotherapy and radiotherapy(RT)alone. …show more content…
This review yielded absolute 2 years’ survival benefit of 8% in favour of chemoradiotherapy arm. In addition, there were a reduction in the risk of death (HR 0.71, 95 %CI 0.64- 0.80) and improve progression free survival PFS and loco regional control in favour of chemoradiotherapy arm. Furthermore, there were no significant difference in the frequency of chemotherapy whether weekly or 2-4weekly. The chemotherapies regimen used were carboplatin/cisplatin combined with either, vinorelbine or paclitaxel. As expected, treatment related toxicities grade 3 and 4 were worse in CRT arm versus RT alone; also it was noted increase in the treatment related death especially in the concurrent group (RR 1.38, 95%CI 0.51—3.27), pneumonitis (RR 1.06), oesophagitis (RR 1.76) and neutropenia (RR 3.53). However, no difference noted in myelopathy, lung fibrosis or oesophageal stricture …show more content…
However, we should carefully select patients with good performance status with no major contraindication to chemotherapy. Unfortunately, majority of patients with lung cancers are life long smokers and have multiple comorbidities including COPD, cardiac problems, chronic kidney impairment which makes the decision of radical treatment with CRT rather challenging. It is essential for oncologist to able to assess performance status accurately before considering patient for radical treatment. Unfortunately, there are some elements of intra and inter-observer variability when assessing performance status 14.
At my current oncology centre ,we follow the London cancer guideline (June 2014) which advocate when managing stage IIIA NSCLC the use of concurrent chemo radiotherapy with dose 60-66 Gy in 30-33 fractions or 55 Gy in 20 fractions, however if unable to deliver chemotherapy, patient should be referred for CHART which gives equivalent survival benefit comparing to concurrent CRT, In my experience CHART isn’t frequently adopted due to practicalities issues such patient traveling to specific oncology center where CHART regimen delivered
Case 1:
A 60-year-old man with history of breathlessness and cough. Lung function revealed FEV1 1.60, TLCO (60% predicted) and patient’s performance status was 1. Subsequently, he had staging CT scan/PET scan/EBUS and all the investigations revealed the final diagnosis stage IIIA T3N2(sub carinal lymph nodes metastasis) M0 Non small cell lung cancer squamous (NSCLC). The patient’s case was discussed at the lung MDT, decision was for concurrent chemoradiotherapy (CRT).
I will be discussing the evidence for using concurrent chemoradiotherapy (CRT) in stage III NSCLC comparing to sequential chemoradiotherapy and radiotherapy(RT)alone. …show more content…
This review yielded absolute 2 years’ survival benefit of 8% in favour of chemoradiotherapy arm. In addition, there were a reduction in the risk of death (HR 0.71, 95 %CI 0.64- 0.80) and improve progression free survival PFS and loco regional control in favour of chemoradiotherapy arm. Furthermore, there were no significant difference in the frequency of chemotherapy whether weekly or 2-4weekly. The chemotherapies regimen used were carboplatin/cisplatin combined with either, vinorelbine or paclitaxel. As expected, treatment related toxicities grade 3 and 4 were worse in CRT arm versus RT alone; also it was noted increase in the treatment related death especially in the concurrent group (RR 1.38, 95%CI 0.51—3.27), pneumonitis (RR 1.06), oesophagitis (RR 1.76) and neutropenia (RR 3.53). However, no difference noted in myelopathy, lung fibrosis or oesophageal stricture …show more content…
However, we should carefully select patients with good performance status with no major contraindication to chemotherapy. Unfortunately, majority of patients with lung cancers are life long smokers and have multiple comorbidities including COPD, cardiac problems, chronic kidney impairment which makes the decision of radical treatment with CRT rather challenging. It is essential for oncologist to able to assess performance status accurately before considering patient for radical treatment. Unfortunately, there are some elements of intra and inter-observer variability when assessing performance status 14.
At my current oncology centre ,we follow the London cancer guideline (June 2014) which advocate when managing stage IIIA NSCLC the use of concurrent chemo radiotherapy with dose 60-66 Gy in 30-33 fractions or 55 Gy in 20 fractions, however if unable to deliver chemotherapy, patient should be referred for CHART which gives equivalent survival benefit comparing to concurrent CRT, In my experience CHART isn’t frequently adopted due to practicalities issues such patient traveling to specific oncology center where CHART regimen delivered