Lung cancer – Related resources

Cochrane reviews

• Radical radiotherapy may result in a better survival that might be expected had treatment not been given .
• No particular radiotherapy regimen appears to provide greater palliation than others for symptoms of patients with non-small cell lung cancer. Patients with better performance status may benefit from the use of high dose palliative regimes . Combination of radiotherapy and chemotherapy is effective in limited stage small cell lung cancer (SCLC). In stage I and II non-small cell lung cancer (NSCLC), post-operative radiotherapy is not shown to extend survival. In stage III NSCLC, radiotherapy may improve short-term survival. Prophylactic brain irradiation reduces the risk of brain metastases from SCLC . Docetaxel may slightly improve the prognosis for patients with relapsed non-small cell lung cancer. Pemetrexed may have similar clinical efficacy as docetaxel but with fewer side effects . There may be no impact on long-term survival whether chest radiotherapy is given within 30 days after the start of chemotherapy or later for patients suffering from limited small cell lung cancer . Docetaxel may slightly improve the prognosis for patients with relapsed non-small cell lung cancer. Pemetrexed may have similar clinical efficacy as docetaxel but with fewer side effects . There appears to be no impact on long-term survival whether chest radiotherapy is given within 30 days after the start of chemotherapy or later for patients suffering from limited small cell lung cancer . Pemetrexed disodium in combination with cisplatin and with folic acid and vitamin B12 supplementation may improve survival in malignant pleural mesothelioma in good performance status patients as compared to cisplatin alone .
• Low molecular weight heparin (LMWH) reduces symptomatic venous thromboembolism and increases minor bleeding events in ambulatory cancer patients with no standard therapeutic or prophylactic indication for anticoagulation. LMWH appears to have a survival benefit in patients with small cell lung cancer at 12 months.
• Oral anticoagulation is not effective for prolonging survival in patients with cancer . External beam radiation therapy (EBRT) seems to be more effective for palliation than endobronchial brachytherapy (EBB) alone in non-small cell lung cancer although the evidence is insufficient .
• Platinum-based chemotherapy regimens appear not to provide significant benefit over non-platinum regimens for small cell lung cancer in terms of survival but appear to provide better complete tumour response rates .
• Compared to surgery alone, postoperative radiotherapy decreases survival of patients with early stage completely resected non-small cell lung cancer.
Screening of asymptomatic individuals for lung cancer with chest radiography, sputum cytology or computed tomography appears not to reduce lung cancer-related mortality. Annual low-dose CT screening appears to be associated with a reduction in lung cancer mortality in high-risk smokers, but further data are required. .

Survival time can be increased with chemotherapy, but the effect is small. Chemotherapy can be effective for symptom palliation and should be routinely considered . Post-operative radiotherapy may reduce rates of local recurrence by 11% to 18% among patients with completely resected stage II or IIIA non-small cell lung cancer. However, there is no survival benefit from post-operative radiotherapy alone . The use of vinorelbine appears to be an option as a first-line treatment of patients with locally advanced or metastatic non-small cell lung cancer . Thoracic radiotherapy in addition to chemotherapy leads to a 14% reduction in mortality corresponding to a 5% improvement in 3-year survival .

Other Internet resources

• Small cell lung cancer. Orphanet ORPHA70573

Literature

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• Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J, International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004 Jan 22;350(4):351-60.
• Cufer T, Ovcaricek T, O'Brien ME. Systemic therapy of advanced non-small cell lung cancer: Major-developments of the last 5-years. Eur J Cancer 2012 ( Dec 19)
• Casaluce F, Sgambato A, Maione P ym. ALK inhibitors: a new targeted therapy in the treatment of advanced NSCLC. Target Oncol 2013;8(1):55-67.
• Douillard JY, Rosell R, De Lena M et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 2006 Sep;7(9):719-27.
• Thatcher N, Chang A, Parikh P et al. Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer). Lancet 2005 Oct 29-Nov 4;366(9496):1527-37.
• Shepherd FA, Rodrigues Pereira J, Ciuleanu T et al; National Cancer Institute of Canada Clinical Trials Group. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 2005 Jul 14;353(2):123-32.
• Molina JR, Adjei AA, Jett JR. Advances in chemotherapy of non-small cell lung cancer. Chest 2006 Oct;130(4):1211-9.
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