Does lung cancer have conservative treatment and chemotherapy?

The main treatment methods of lung cancer include surgery, chemotherapy (including molecular targeted therapy), radiotherapy and immunotherapy. Surgical treatment is one of the effective treatment methods for non-small cell lung cancer. The application of targeted drugs has changed the traditional treatment mode of non-small cell lung cancer and made individualized treatment a new direction.

Detailed explanation of treatment scheme for lung cancer

Treatment of early lung cancer

Surgical treatment is the main choice. The standard operation includes pneumonectomy/sleeve lobectomy+systematic lymph node dissection, combined with radiotherapy and chemotherapy.

Stage I: Lobectomy or pneumonectomy should be performed as long as physical conditions permit. Preoperative chemotherapy (neoadjuvant chemotherapy) can eliminate distant metastasis of tumor at an early stage, improve surgical resection rate, improve local control of tumor and prolong the survival time of patients. Postoperative chemotherapy is not recommended for patients after radical resection. However, for high-risk patients with stage IB, four cycles of adjuvant chemotherapy are still needed. For patients with poor lung function who can't tolerate thoracotomy, if the indications are consistent, video-assisted thoracoscopy can be used, with less postoperative trauma and faster recovery. Stereotactic ablation radiotherapy (SABR) is the first choice for patients with cardiopulmonary insufficiency and other patients who are not suitable for surgery. Postoperative radiotherapy is not recommended for surgical patients unless the margin is positive or the elevation period is N2.

Stage II: Lobectomy or pneumonectomy should be performed as long as physical conditions permit. Preoperative chemotherapy (neoadjuvant chemotherapy) can eliminate distant metastasis of tumor at an early stage, improve surgical resection rate, improve local control of tumor and prolong the survival time of patients. For patients after radical resection, four cycles of postoperative chemotherapy based on cisplatin are recommended. You can check Kenji Suzuki, and if there are any unfavorable factors, combine radiotherapy and chemotherapy. The curative effect of concurrent chemoradiotherapy is better than sequential and single therapy, but due to the large adverse reactions and poor patient tolerance, sequential or alternating mode is still adopted at present. The postoperative recurrence rate and metastasis rate are high. Adenocarcinoma has a tendency of distant metastasis.

Local progressive stage

Some patients with stage IIIa can receive surgical treatment. Chemotherapy is the main treatment for patients who have lost the chance of radical surgery.

Stage Ⅲ A: Some patients can receive surgical treatment. Patients with non-small cell lung cancer who are generally in good condition, with limited local lymph node metastasis and no blood metastasis, but have invaded mediastinal organs and pleura, can undergo extended radical resection of lung cancer. Preoperative chemotherapy can be considered. For patients after radical resection, it is suggested to use cisplatin-based postoperative chemotherapy or combined radiotherapy and chemotherapy. The curative effect of concurrent chemoradiotherapy is better than sequential and single therapy, but due to the large adverse reactions and poor patient tolerance, sequential or alternating mode is still adopted at present.

Stage ⅲ b: preoperative chemotherapy or radiotherapy should be given before surgical treatment. Patients who cannot undergo surgery can benefit from a combination chemotherapy regimen containing platinum. Local synchronous radiotherapy and chemotherapy can obviously improve the local control rate and survival rate.

later stage

Stage Ⅳ: For solitary metastatic lung cancer (solitary brain metastasis, solitary adrenal metastasis, contralateral lung or ipsilateral solitary pulmonary nodule), it should be treated by stages according to the primary lesion. Other conditions are not suitable for surgical treatment and require systemic treatment. Patients can benefit from the combination chemotherapy scheme composed of platinum and can be combined with radiotherapy. The specific treatment strategy depends on the metastasis site, physical activity score, EGFR and ALK mutation, etc. Before treatment, patients should try to detect EGFR gene mutation and ALK and ROS- 1 fusion gene.

There is no such thing as conservative treatment ~

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