Methods of treatment of lung cancer

Content

  • Surgical treatment of lung cancer
  • Radiation therapy in the treatment of lung cancer
  • Chemotherapy in the Treatment of Lung Cancer

  • In lung cancer patients used three main methods of cancer treatment - surgery, radiation therapy for lung cancer,
    chemotherapy and various combinations thereof. Tactics of treatment set
    considering histological structure and extent of the tumor and
    the age and functional status of the patient, and opportunities
    clinical settings.

    The main method of treatment of lung cancer, providing the possibility of a stable cure, is to undergo surgery. The history of surgical treatment of lung cancer
    has more than 70 years, when in 1933 the American surgeon Grehem
    for the first time successfully completed a combined pneumonectomy.

    Despite the constant improvement of surgical technique, long-term outcomes of lung cancer operations
    We have not changed much throughout the world for the past 30 years and leave
    much to be desired. Only 30-40% of radically operated lung cancer patients
    experiencing control 5-year term. The majority of them within
    2-3 years after surgery the tumor process progression occurs
    with lesions of intrathoracic lymph nodes, lung or residue
    distant organs. This is due to the biology of the tumor,
    that despite the seeming radical surgery is often already
    generalized disease.

    Given the fact that patients with interoperabilityestablished diagnosis of lung cancer is on average 20-25%, it is evident that only a small proportion of patients have a chance to recover. Late diagnosis of lung cancer
    defines a large percentage palliative surgery - when in connection with
    high prevalence of the process is clearly not possible to completely remove
    tumor tissue. In such cases, surgical intervention is often
    It aims to eliminate life-threatening complications - bleeding,
    suppuration, breakthrough of the tumor in the chest cavity, etc.



    Surgical treatment of lung cancer

    Surgical treatment of patients with resectable (potentially remove the oil) forms of lung cancer
    It is a radical and most promising method that gives real
    prospects for full recovery. After the first successful operations
    easy removal in the 30-ies of XX century, the method of permanently
    improved, with the greatest progress has been made in the last two
    decades. To date, methodical and
    technical aspects of the surgical intervention, evidence identified to
    surgery and lung cancer
    the choice of its volume, the main issues studied anesthesiology, intensive
    therapy before and after surgery, the prevention and treatment of postoperative
    complications.

    In resectable (potentially remove the oil) forms of non-small cell lung cancer (I-III stage) surgical treatment is the treatment of choice. By clarifying the indications for surgery in lung cancer
    these stages have in mind not so much the definition of its expediency,
    as the possibility of the establishment of the fundamental
    surgical benefits, which is achieved by evaluating contraindications.
    Over the past two decades, sharply narrowed contraindications
    Oncological and functional plan for surgery
    patients with lung cancer.

    Methods of treatment of lung cancer
    A significant number of patients with lung cancer
    there are contraindications for surgery
    functional type. These include low compensatory opportunities
    respiration and blood circulation, serious comorbidities
    (Heart failure II and III level, expressed by organic
    changes in the heart; hypertension III degree .;
    kidney or liver failure, and others.). The evaluation
    contraindications when lung cancer is always a subjective element.

    On the unreasonable refusal of surgery patients with lung cancer
    It affects the opportunities and practical experience in a medical institution.
    Modern possibilities of anesthesiology and intensive care allow
    often prevent dysfunction of organs and systems, especially in
    adequate preoperative preparation. Refusal of operations
    oncology products should also be seriously motivated. This
    the question needs to be addressed jointly with the obligatory participation
    Thoracic surgeon with experience in surgical treatment of lung cancer.

    The standard operations for lung cancer
    are pneumonectomy (removal of the entire lung) and lobectomy (removal
    one lobe), as well as variants thereof (extended and
    Combined surgery, lobectomy with sleeve resection
    bronchi and others.). Bronhoplasticheskie operation empower
    surgical technique and contribute to improve the resectability
    20% of newly diagnosed lung cancer patients
    this localization. The scope and nature of the operation, the surgeon determines
    Depending on the location and extent of the primary tumor, its
    relationship to the surrounding organs and structures, state of intrathoracic
    lymph nodes.

    The greatest achievement of recent years is the possibility of a true diagnosis of early forms of central lung cancer
    (Carcinoma in situ, microinvasive cancer) that can be cured
    not only the operational method and radiation (intraluminal) or photodynamic therapy. When the last of lung cancer patients injected
    the photosensitizer, which accumulates mainly in cancer
    cells, and then performed via bronchoscope rays irradiation
    a laser of a certain wavelength. The results justify the use of
    technique - the cure is achieved in more than 90% of patients.

    Operations in lung cancer
    fraught with many dangers, sometimes resulting in intraoperative and / or
    postoperative complications and postoperative mortality
    (Mortality). Improved surgical techniques and
    anesthetic, as well as the implementation of a comprehensive
    Intensive therapy prior to surgery and early after it
    promoted in recent years, a dramatic reduction in the frequency
    postoperative complications.

    Postoperative mortality rate - the main indicator in evaluating the immediate results of surgical treatment of patients with lung cancer.
    In the early days, when they started to carry out surgery,
    postoperative mortality was extremely high - up to 25%. AT
    the last two decades, advances in surgery has resulted in an appreciable
    reduction - about 3-4%.

    In Lung Cancer Stage I
    surgical method allows to achieve cure 70-80% of patients, II
    stage, ie metastases in nearby lymph nodes - around
    40% and in stage III, ie, metastatic more
    distant lymph node groups - only 15-20%. Most cases
    death from recurrence and metastasis of lung cancer
    It occurs within the first 2-3 years after surgery. If patients safely
    survive this critical period and under the control dynamic
    observation they do not show the progression of the process, the forecast
    It is favorable.

    Unfortunately, the majority of patients diagnosed with the disease
    very late, in stages III-IV, many identify different
    contra-functional plan, and they are found inoperable.
    Troubleshooting in the organization of active detection of early forms
    disease in primary and qualifying diagnosis of lung cancer,
    use of the most efficient methods of investigation, as well as
    rational choice of treatment tactics in accordance with modern achievements
    Clinical Oncology, close clinical supervision after
    Treatment, of course, will increase the efficiency of this therapy formidable
    disease.



    Radiation therapy in the treatment of lung cancer

    Second most effective treatment for lung cancer is radiation therapy. In non-small cell lung cancer
    radiation treatment is carried out by a radical program or
    palliation. Radical radiotherapy provides
    and obtaining a long lasting effect resulting in the death of all
    cells of the primary tumor and metastases intrathoracic.

    Cancer Radiotherapy lung
    carried out by remote gamma settings and betatron
    linear accelerators, braking and generating electron radiation
    energies from 4 to 35 MeV. There are many methodological choices radiation therapy for lung cancer.
    for curative radiation therapy available for patients with locally
    lung tumor process (I-II stage), which operation
    contraindicated or they are abandoned. The cure these patients
    5-10% is reached in observation. Radiation therapy for palliative
    program planning in lung cancer
    Stage III. In incompletely operated patients and
    cancer progressing after radiotherapy surgery is often combined with
    polychemotherapy.

    The immediate effect of radiation therapy for lung cancer
    It depends on the prevalence of the process, histological structure
    tumors, a total focal dose quantities. Half of the patients manage
    achieve complete resorption of the primary tumor and regional metastases,
    and 40% - reduction in intrathoracic tumor process.



    Chemotherapy in the Treatment of Lung Cancer

    lung cancer chemotherapy in the past decades has become more effective thanks to the synthesis of new medicines. In small cell lung cancer
    it is the primary method of treatment and its effectiveness reaches
    60-80%, sometimes with complete resorption (resorption) of the tumor, which actually extends
    life is about 50% of patients. In the early stages (I) of this histological
    forms of lung cancer treatment of choice is surgery, but always with postoperative mnogokursovoy (4-6) polychemotherapy.

    In non-small cell lung cancer
    immediate objective improvement (partial resorption (resorption) primary
    tumor, regional and distant metastases) chemotherapy
    It is achieved in 10-30% of patients, however, complete resorption occurs rarely.
    It is carried out with contraindications to surgery and radiation treatment,
    as well as an additional operation to the treatment with
    Locally process in tumor progression after
    surgical treatment.

    Chemotherapy long-term (up to 6-8 courses) following
    drugs in various combinations: doxorubicin, procarbazine,
    cisplatin, vincristine, etoposide, cyclophosphamide, methotrexate,
    bleomycin, ifosfamide, irinotecan, taxotere, taxol, vinorelbine,
    gemcitabine, etc. The intervals between courses of chemotherapy -. 3-4 weeks.

    Methods of treatment of lung cancer
    Best results are achieved with a combination of chemotherapy and radiotherapy for lung cancer (chemoradiation), with possible simultaneous or sequential use them.

    Possible toxic effects of chemotherapy include nausea,
    vomiting, intestinal disorders, phlebitis, cystitis, dermatitis, allergic
    reactions, etc.. The most common late complication is depression
    hematopoiesis. Therefore blood tests are repeated at least 2 times a week
    within two weeks after completion of chemotherapy.

    Improving the efficiency of surgical treatmentpatients with non-small cell lung cancer stage III is connected with the development of combination therapies, providing a combination of radical surgery with radiation therapy for lung cancer
    and / or anticancer drug treatment. Additional methods
    is used before or after surgery, during it, as well as pre- and
    postoperative periods. Many questions of the combined treatment of lung cancer
    It remains controversial and unclear. However, it is obvious that in stage III
    the combined treatment results are better than one surgery.

    Often, patients with locally advanced lung cancer
    come to the hospital with severe respiratory failure on the background
    obstruction (blockage) tumor of the trachea and the large bronchi, when it
    It is, above all, on an emergency to eliminate threats
    Life respiratory and cardiopulmonary diseases. Designed
    algorithm for the treatment of this group of patients with lung cancer with the use of high-tech modern methods.

    Summarizing all the above, we can conclude that effective treatment of lung cancer is possible only when it is detected early enough before the onset of clinical symptoms. Active detection of lung cancer
    In preclinical period remains a priority organizational
    medical interventions, improving long-term outcomes.
    Running at an early stage of organ or surgical
    endoscopic treatment not only gives hope to cure the patient,
    and simultaneously provides better preservation and disability
    quality of life of patients.

    It is hoped that on the one hand a well-coordinated work
    medical, and social and government structures, and on the other -
    awareness and serious attitude toward our own health
    of the population in terms of achievements XXI-st century will make a real increase
    effectiveness of the fight against this malignant disease.

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