TAILIEUCHUNG - Chapter 085. Neoplasms of the Lung (Part 15)

Bulky NSCLC Stage IIIA and Dry IIIB (IIIB Without a Pleural Effusion) The presence of pathologically involved N2 nodes should be confirmed histologically because enlarged nodes detected by CT will be negative for cancer in ~30% of patients. Chemotherapy plus radiation therapy is the treatment of choice for patients with bulky stage IIIA or IIIB disease without pleural effusion (referred to as "dry IIIB"). Randomized studies demonstrate an improvement in median and long-term survival with chemotherapy followed by radiation therapy, compared with radiation therapy alone. Subsequent randomized trials have shown that administering chemotherapy and radiation therapy concurrently results in improved. | Chapter 085. Neoplasms of the Lung Part 15 Bulky NSCLC Stage IIIA and Dry IIIB IIIB Without a Pleural Effusion The presence of pathologically involved N2 nodes should be confirmed histologically because enlarged nodes detected by CT will be negative for cancer in 30 of patients. Chemotherapy plus radiation therapy is the treatment of choice for patients with bulky stage IIIA or IIIB disease without pleural effusion referred to as dry IIIB . Randomized studies demonstrate an improvement in median and long-term survival with chemotherapy followed by radiation therapy compared with radiation therapy alone. Subsequent randomized trials have shown that administering chemotherapy and radiation therapy concurrently results in improved survival compared to sequential chemotherapy and radiation therapy albeit with more side effects such as fatigue esophagitis and neutropenia. Frequently an additional two to three cycles of chemotherapy are also given. However it is not clear whether these additional cycles should be administered before or after the chemoradiation what the optimal drugs are or whether doses should be attenuated during the radiation but given more frequently. Lower doses of drugs may sensitize the tumor to radiation therapy but may not by themselves remove other microscopic disease. Disseminated Non-Small Cell Lung Cancer Symptomatic Management of Metastatic Disease Patients who present with or progress to metastatic NSCLC have a poor prognosis as do patients with pleural effusions. Untreated the median survival of both of these patient groups is roughly 4-6 months. They are often treated in the same way. Standard medical management the judicious use of pain medications the appropriate use of radiotherapy and outpatient chemotherapy form the cornerstone of this management. Palliative Radiation Therapy Patients whose primary tumor is causing urgent severe symptoms such as bronchial obstruction with pneumonitis hemoptysis upper airway or superior vena cava .

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