Treatment

In Germany, the optimal therapy for each patient is selected at an interdisciplinary conference, which is attended by surgeons, oncologists, doctors involved in radiation therapy.

Therapy for lung carcinoma relies on the following:

• operation
• chemotherapy
• radiation therapy
• chemotherapy in combination with other methods

What is the correct treatment? It depends on many factors, for example:

• on the general health of the patient,
• on the prevalence of his disease, i.e. stages
• from the microscopic type of carcinoma: small cell or non-small cell lung cancer, and what form of non-small cell carcinoma?

The best prognosis is for patients in whom surgical removal of the tumor is possible completely, or it can be destroyed by other therapeutic methods. It succeeds mainly only in the early stages of the disease.

With non-small cell lung cancer, doctors try, if possible, to operate on the tumor.

With small cell lung cancer, doctors turn primarily to chemotherapy, in the early stages also with the prospect of recovery. Only very small tumors are operated on under certain conditions, but even then patients receive additional chemotherapy.

Decisive in the choice of therapy are the type of tissue (non-small cell lung carcinoma or small cell lung carcinoma), the stage of the tumor, as well as concomitant diseases.

Operation

The operation plays a role, first of all, in non-small cell lung cancer. Small cell lung cancer often grows very quickly and spreads early through the lymphatics and bloodstream throughout the body. In such cases, surgery often does not make sense, since the tumor cannot be completely removed. Operations are done in cases where, due to the size of the tumor, neighboring organs are compressed.

The question of surgery arises, first of all, when the tumor is not too large and daughter tumors, the so-called metastases, have not formed in other organs. And the condition of the patient plays a role.

Before surgery, lung function is examined to make sure that the remaining parts of the lungs can provide respiratory function. It is often necessary to remove a lobe of the lungs, and in very large tumors, one of the lungs completely.

Chemotherapy

Chemotherapy in the treatment of lung cancer plays a very important role for most patients, as before. Small cell tumors are mainly treated with chemotherapy, as they are especially sensitive to it. For non-small cell lung cancer in the early stages, chemotherapy is recommended after surgery as a so-called adjuvant therapy. In advanced stages, when the tumor has already invaded distant lymph nodes or other organs, chemotherapy may be given in combination with radiation therapy or targeted therapy.

Chemotherapy acts systemically, which means - in the whole body. More often, intravenously administered active substances are distributed to all organs and can reach and destroy not only the cancer itself in the lungs, but also already dispersed cancer cells.

Treatment is carried out in cycles, when the phases of treatment are replaced by pauses in treatment. During the pause, the body gets the opportunity to regenerate healthy tissues, which often recover faster after chemotherapy than tumor tissue. A lot of treatment cycles are carried out in order to affect also those tumor cells that were in a quiet phase immediately before, and the therapy could not act on them because of this.

There are different classes of active substances of cytotoxic drugs that can be used in various combinations. Thus, they hope to reach as many tumor cells as possible.

Radiation therapy

Radiation therapy is performed either initially for limited inoperable non-small cell lung carcinomas without distant metastases or as postoperative radiation for lesions of certain lymph nodes after surgery for non-small cell lung carcinoma. Cobalt, which was previously used as a radiation source, has been replaced today in Germany with a linear accelerator due to small side effects. Also, isolated metastases in the brain or bones can be well treated with radiation therapy. A novelty of recent years is stereotaxic irradiation using a linear accelerator. In this case, in a short time of treatment, the patient receives significantly higher single doses with a greater likelihood of success and with low side effects. The condition for such treatment is the presence of locally limited tumor growth without other manifestations of the tumor process. This method is also an alternative form of treatment for isolated lung metastases.

Radiation therapy for non-small cell lung cancer is recommended for advanced stages (III and IV) and only in combination with chemotherapy. In small cell lung cancer at a limited stage of tumor development, radiation therapy is carried out in addition to chemotherapy, when the lymph nodes are already affected or when the tumor tissue could not be completely removed during the operation.