General Information
Note: Separate PDQ summaries on Small Cell Lung Cancer Treatment 1; Lung Cancer Prevention 2; and Lung Cancer Screening 3 are also available.
Note: Estimated new cases and deaths from lung cancer (non-small cell and small cell combined) in the United States in 2008:[1]
- New cases: 215,020.
- Deaths: 161,840.
Non-small cell lung cancer (NSCLC) is a heterogeneous aggregate of histologies. The most common histologies are epidermoid or squamous carcinoma,
adenocarcinoma, and large cell carcinoma. These histologies are often
classified together because approaches to diagnosis, staging, prognosis, and treatment are similar. Patients with resectable disease may be cured by surgery or surgery with adjuvant chemotherapy. Local control can be achieved with radiation therapy in a large number of patients with unresectable disease, but cure is seen only in a small number of patients. Patients with locally advanced, unresectable disease may have long-term survival with radiation therapy combined with chemotherapy. Patients with advanced metastatic disease may achieve improved survival and palliation of symptoms with chemotherapy.
At diagnosis, patients with NSCLC can be divided into three groups that reflect both the
extent of the disease and the treatment approach.
The first group of patients has tumors that are surgically resectable
(generally stage I, stage II, and selected stage III tumors). This group has the best prognosis,
which depends on a variety of tumor and host factors. Patients with resectable
disease who have medical contraindications to surgery are candidates for
curative radiation therapy.
Adjuvant cisplatin-based combination chemotherapy may provide a survival advantage to patients with resected stage IB, stage II, or stage IIIA NSCLC.
The second group includes patients with either locally (T3–T4) and/or regionally
(N2–N3) advanced lung cancer. This group has a diverse natural history. Selected patients with locally advanced tumors may benefit from combined modality treatments. Patients with unresectable or N2–N3 disease are
treated with radiation therapy in
combination with chemotherapy. Selected patients
with T3 or N2 disease can be treated effectively with surgical resection and either preoperative or postoperative chemotherapy or chemoradiation therapy.
The final group includes patients with distant metastases (M1) that were found at the time of
diagnosis. This group can be treated with radiation therapy or chemotherapy
for palliation of symptoms from the primary tumor. Patients with good
performance status (PS), women, and patients with distant metastases confined to a
single site live longer than others.[2] Platinum-based chemotherapy
has been associated with short-term palliation of symptoms and with a survival
advantage. Currently, no single chemotherapy regimen can be recommended for
routine use.
Patients previously treated with platinum combination chemotherapy may derive symptom control and survival benefit from docetaxel, pemetrexed, or epidermal growth factor receptor inhibitor.
Multiple studies have attempted to identify prognostic determinants after surgery and have yielded conflicting evidence as to the prognostic importance of a variety of clinicopathologic factors.[2-6] Factors that have correlated with adverse prognosis include the following:
- Presence of pulmonary symptoms.
- Large tumor size (>3 cm).
- Nonsquamous histology.
- Metastases to multiple lymph nodes within a TNM-defined nodal station.[7-17]
- Vascular invasion.[3,18-20]
- Increased numbers of tumor blood vessels in the tumor specimen.
Similarly, conflicting results regarding the prognostic importance of aberrant expression of a number of proteins within lung cancers have been reported. For patients with inoperable disease, prognosis is adversely affected by poor PS and weight loss of more than 10%. These patients have been excluded from clinical trials evaluating aggressive multimodality interventions. In multiple retrospective analyses of clinical trial data, advanced age alone has not been shown to influence response or survival with therapy.[21]
Because treatment is not satisfactory for almost all patients with NSCLC, eligible patients should be considered for clinical trials. Information about ongoing clinical trials is available from the NCI Web site 4.
References
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