What are the main treatments for NSCLC
surgery
RT
chemo
immune therapy
what are the signs and symptoms
persistent cough
shortness of breath
coughing up blood
pain in chest
loss of appetite
what determines how you manage NSCLC
performance status
comorbidities
spirometry
shuttle walk test
what treatments would you offer stage T1a-T2b
- lobectomy
- bibloectomy
- segmentectomy
- SABR or hypofractionated RT
- 54Gy in 3# over 5-8 days
what treatments would you offer stage 3a +3b
- concurrent chemo
- 60-66Gy in 30-33#
- neoadjuvant chemo fololowed by sequential RT
- if spread to mediastinal nodes and adjacent soft tissue then conbined surgery, RT, and chemo
- 45Gy in 25# with surgery 3-5 weeks later
what treatment would you offer stage 3+4
- primary chemo
- targeted therapies such as epidermal growth factor, anaplastic lymphatic kinase
- immune therapy as primary treatment to block the cancer cells ability to supress T-cells
what SABR prescriptions would you give
18Gy in 3#
12Gy in 5#
11Gy in 5#
why is SABR superior to conventional RT
it shows improved side effects and small gain in local control rates and is better to treat peripheral leisions
what are the challenges with RT
- tumour often a moving targert
- spinal cord and heart can be dose limiting
- 4DCT and CBCT
- patient not fit enough to breath hold
what are the different ways to diagnose
chest x-ray
CT or PET-CT
MRI
bronchoscopy
ultrasound
biopsy
who has a worse local control rate
smokers
what are the side effects
fatigue
hair loss
coughing
shortness of breath
weight loss
sore throat
week immune system
pain
why is RT superior
- for people who are not fit enough to withstand surgery
- for people who cant tolerate chemo
