Treatment of Non-Small Cell Lung Cancer

Early-Stage Disease

The British medical community recommends phẫu thuật cắt bỏ hoàn toàn với nạo vét hạch trung thất đồng bên as the standard treatment for patients with stage I (T1-2N0) and stage II (T1-2N1, T3N0) non-small cell lung cancer 1, 2.
Cắt thùy phổi hoặc cắt toàn bộ phổi với nạo vét hạch is the foundation of surgical treatment for non-small cell lung cancer 1.
Cắt toàn bộ phổi has a higher surgical risk but better treatment outcomes for non-small cell lung cancer 1.
For elderly patients or those with respiratory dysfunction, cắt phân thùy or cắt không điển hình may be considered as an exception 1, 2.
Xạ trị bổ trợ sau phẫu thuật is not recommended for patients with stage I and II N0-N1 non-small cell lung cancer if complete resection is achieved 1, 2, 3.

Hóa trị tân bổ trợ ngắn hạn containing cisplatin and at least one other drug, and xạ trị ngoài với liều tối ưu is the standard treatment for patients with unresectable stage IIIA non-small cell lung cancer 3, 4, 5.
For patients with resectable stage IIIA non-small cell lung cancer, complete resection with extensive lymph node dissection is an option 3, 4, 5.

Hóa xạ trị đồng thời is the preferred treatment for patients with good performance status and unresectable stage III non-small cell lung cancer 6.
For patients with solitary brain metastasis, surgical resection and/or xạ trị có thể có lợi, with a 5-year survival rate of approximately 10-20% 7.
For patients with solitary adrenal metastasis and resectable lung tumor, surgical resection has resulted in long-term survival in some cases 7.
Hóa trị hai thuốc containing platinum combined with vinorelbine, gemcitabine, or taxane prolongs survival, improves quality of life, and controls symptoms in patients with good performance status 6.

CT ngực xoắn ốc có hoặc không có thuốc cản quang is recommended every 6-12 months after surgery for 2 years, then annually 7.
Đánh giá đáp ứng after 2-3 cycles of chemotherapy by repeating initial radiographic tests shows tumor response 6.
Measurement and reporting of response must follow the RECIST 1.1 criteria 6.

Tư vấn hội chẩn đa chuyên khoa is the standard in this rapidly changing field of treatment 2, 3, 5.
Age is not an absolute contraindication for surgical resection of non-small cell lung cancer in carefully selected patients 1, 2.
Pulmonary function should be evaluated by determining VO2 max, with a surgical threshold of approximately 15 ml/kg/min 1, 2.
Severe vascular disease should be treated before lung surgery 1, 2.
The surgical mortality rate for pneumonectomy should be less than 6%, and for lobectomy should be less than 2% 1.