Is stage II lung cancer curable

The therapy methods depend on the tumor stage, the fine tissue subtype of lung cancer and the patient's personal physical capacity. The earlier a lung cancer is detected, the more favorable the prognosis for the patient. Extensive scientific investigations have made it possible to develop therapy guidelines for lung cancer that are internationally recognized.

Therapy goals

  • Curative therapy:
    If a therapy with the aim of permanent healing can be carried out, then one speaks of "curative therapy". In lung cancer in tumor stages without distant metastases and without evidence of tumor cells in lymph nodes on the opposite side, this is possible if intensive treatment can be carried out.
     
  • Palliative therapy:
    If a tumor has already metastasized to a distance, healing is no longer the primary therapeutic goal. Then one speaks of “palliative therapy”. The goals of palliative therapy must be determined on a case-by-case basis; frequent goals are to extend life with little impairment of quality of life (palliative life-prolonging therapy) and the avoidance or relief of distressing symptoms (palliative symptom-oriented therapy).
 
Therapy of small cell lung carcinoma (approx. 15% of lung carcinomas)

The SCLC is a very rapidly growing aggressive tumor, which forms metastases early. An operation or radiation alone without chemotherapy are therefore rarely useful in this disease.

The small cell lung cancers are divided into

  • Limited disease, i.e. H. the tumor only grows on one side of the chest cavity, the chest wall is not directly affected, and only certain lymph nodes are involved
     
  • Advanced stage (extensive disease), i. H. any extent of the tumor beyond the definition of limited disease, i. d. Usually with involvement of other organs (metastases).

chemotherapy

The cancer cells of the small cell lung carcinoma react particularly sensitively and thus effectively to the chemotherapy. This has the task of acting as a cell poison on the division of the cancer cells and destroying them. In most cases, polychemotherapy is administered with several different individual substances in different combinations.

Patients can receive chemotherapy in the form of capsules, tablets, injections, or infusions. The treatment takes place in several chemotherapy cycles (4-6 cycles) according to a fixed time schedule. There are therapy-free intervals in which the patient can recover between the individual therapy cycles.

Unfortunately, chemotherapy affects not only tumor cells, but also healthy cells in the body that divide quickly. As a result, side effects such as hair loss, damage to the intestinal mucosa or changes in the blood count occur, usually temporarily, and in rare cases persistent. Regular blood count checks are necessary in order to detect a deterioration in the blood count in good time and, for example, to initiate preventive measures to prevent infections. They can also help to individually adjust the intensity of the chemotherapy.

In many patients a partial or even complete remission (decrease / disappearance of the tumor mass) could be achieved through polychemotherapy. The average survival time could thus be significantly increased. Patients with a 'limited disease' tumor have the best chance of recovery.

In the case of advanced lung cancer, palliative chemotherapy can relieve symptoms and extend life. The choice of cytostatics depends largely on the general condition of the patient.

For each tumor patient, the treating doctor will create an individual treatment concept that is not only based on the circumstances of the tumor, but also on the physical and psychological resilience and can be tailored to this.

Studies: Numerous new drugs and innovative therapy methods are continuously being developed. New drugs for the treatment of lung cancer are also available as part of clinical studies at the Ulm University Hospital

Radiation therapy (radiotherapy)

Radiation therapy, like chemotherapy, aims to destroy cancer cells. The cancer cells are to be damaged by a high but targeted radiation concentration, but the healthy tissue is spared.

If patients with a limited tumor are in partial or even full remission (disappearance of the tumor) after successful chemotherapy, radiation therapy can help stabilize the disease status.

The combination of chemotherapy and radiation therapy resulted in an increase in survival time, an increase in the healing rate and longer recurrence-free periods.

Radiation therapy is usually carried out on an outpatient basis over several weeks in small individual doses. This ensures gentle treatment of healthy tissue. After radiation therapy, side effects such as reddening of the skin, discoloration of the skin, induration of the subcutis, difficulty swallowing (radiation field in the esophagus), inflammation of lung tissue, scarring of lung tissue (pulmonary fibrosis) with irritation of the cough and reduced breathing capacity and, in very rare cases, reduced cardiac output, if the heart was also in the radiation field.

Preventive brain radiation

As the patient's lifespan is extended, the likelihood of brain metastases increases. For this reason, brain irradiation is carried out as a preventive measure in patients in whom no tumor can be detected after combined chemotherapy / radiation therapy. This leads to a significant improvement in overall survival and recurrence-free survival. This procedure is practiced in SCLC if the previous therapy (surgery or chemotherapy / radiation therapy) has led to a very good response to therapy.

surgery

As curative (healing) operation the tumor is removed only in question in the rare early stages of small cell lung cancer.

In rare cases, bleeding or persistent infection of the lung tissue occurs due to the spread of the tumor. If the general condition is good and a non-invasive therapy fails, a palliative surgery Provide relief.


Therapy of non-small cell lung cancer (approx. 75-80% of lung cancer)

Treatment for non-small cell lung cancer depends on the stage of the tumor. Surgical removal of the tumor is the standard therapy in stages I and II. Depending on the tumor stage, postoperative chemotherapy (adjuvant therapy) can further improve the chances of recovery. In stages IIIA and IIIB, lung cancer can also be surgically removed under favorable circumstances, but an extended treatment plan is often necessary, which includes chemotherapy, radiation therapy and surgery as treatment options. In the most advanced stage IV with distant metastases, chemotherapy is usually used, possibly supplemented by radiation therapy.

For some subspecies of non-small cell lung cancer, there are newer drugs that are available for treatment. These include, in particular, the substances that embody targeted therapy.

surgery

  • Curative operation:
    Complete removal of the lung cancer offers the best chance of a cure. Up to tumor stage IIB, the surgeon is usually able to completely remove the tumor with a sufficient safety margin without disproportionately impairing the function of the lungs. However, the actual extent of the tumor can only be determined with certainty during the operation and the further course of action can sometimes only be decided here at short notice. In some cases, surgery can also be carried out at a more advanced stage of the tumor. Depending on the spread of the disease, the operation can be more or less extensive. Sometimes individual lobes have to be removed, in less favorable cases an entire lung.
     
  • Palliative surgery:
    In rare cases, bleeding or persistent infection of the lung tissue occurs due to the spread of the tumor. In the case of a good general condition and failure of alternative therapies, an operation can help here too. The aim of this palliative operation is to alleviate symptoms.


Radiation therapy (radiotherapy)

A primary radiation (radiation as first therapy) occurs when the lung tumor cannot be surgically removed.

A secondary radiation (radiation as secondary therapy) takes place when the tumor could not be completely removed surgically and the tumor cells remaining in the body are to be destroyed.

A adjuvant radiation (Radiation after an operation) is carried out if the primary operation reveals major lymph node involvement (N2). As a rule, adjuvant radiation therapy follows adjuvant chemotherapy in these patients with the aim of improving tumor-free survival.

Palliative radiation therapy: In the case of painful metastases or bone metastases that endanger the stability of the bone, radiation can often bring about a rapid improvement in the symptoms.

Combined chemoradiotherapy

The combination of radiation therapy with drug tumor therapy is more effective than radiation therapy alone. The choice of medication depends on the patient's comorbidity.

chemotherapy

Adjuvant chemotherapy (given after surgery):
In patients with tumors in tumor stage II-III, chemotherapy is indicated after surgery to further improve the chance of recovery.

Neoadjuvant chemotherapy (given before surgery):
Studies have shown that in the case of advanced non-small cell lung cancer, neoadjuvant chemotherapy (before the operation) can create better conditions for an operation in some cases. In the best case, the tumor is reduced in size by chemotherapy and can thus be removed surgically more safely.

Palliative chemotherapy:
With new drugs, palliative chemotherapy for patients with metastatic non-small cell lung cancer is gaining in importance. Modern chemotherapeutic agents are well tolerated and can extend the lifespan and improve tumor-related symptoms or delay their occurrence.

Therapy with new targeted substances

For certain types of lung cancer, antibodies against a vascular growth factor (VEGF) are now available (bevacizumab), which can be combined with classic chemotherapy. In addition, a tablet therapy has been developed that inhibits the action of a specific surface molecule (EGFR), which is particularly common on lung cancer cells.

Targeted therapy with tablets can be carried out, for example, if there are changes in the EGFR. The drugs (e.g. Afatinib, Gefitinib, Erlotinib) work in the tumor cell, where they inhibit tumor growth by blocking a certain signaling pathway. The drugs are usually better tolerated than "normal" chemotherapy.

Osimertinib can be used to treat patients with such an EGFR mutation who have become resistant to the tumor and who have another mutation (T790 M).

Patients in whom changes in EML4-ALK are found in the tumor tissue can benefit from tablet therapy with crizotinib and ceritinib.

In addition, the EGFR antibody necitumumab can be given in addition to chemotherapy in certain patients.

Studies: Numerous new drugs and innovative therapy methods are currently being developed. New drugs for the treatment of lung cancer are also available at the Ulm University Hospital as part of clinical studies. (Study Center )

If the disease is progressing during the first chemotherapy, it may make sense to switch to other medications. As a targeted therapy in the 2nd line of therapy, a combination of chemotherapy with the substances nintedanib or ramucirumab may be possible.

Palliative bronchoscopic therapy for lung cancer

Bronchoscopy is increasingly used not only to make a diagnosis, but can also provide relief to the patient as a palliative therapy. If the airways are blocked by secretion, tissue or blood, various methods such as suctioning off secretions, compressing bleeding sources, laser removal of tumor tissue, inserting tubes (stents) to keep narrowed areas open, can make breathing much easier for the patient.