Treatment Options

Treatment options for lung cancer vary depending upon the kind and stage of the disease. It is important to know if you have been diagnosed with non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Knowing as much as you can about the kind and stage of your lung cancer will help to you better identify and understand your options for treatment. Staging indicates the size or extent of the cancer, and indicates if it has spread.

NSCLC has several subtypes, the most common of which are adenocarcinoma, squamous cell carcinoma and large cell carcinoma. NSCLC is staged in four stages: I, II, III, and IV. For more information on staging in NSCLC, please go here. If NSCLC is found at an early stage, surgery is generally an option. In later stage NSCLC, chemotherapy and/or targeted therapies are used, with or without radiation.

SCLC is staged as either limited or extensive. For more information on staging in SCLC, please go here. Occasionally, surgery may be an option for SCLC but chemotherapy, often with radiation, is generally the recommended treatment.

Treatment options differ for each individual and may depend on other factors such as age, physical condition, other medical problems, and where the cancer is located. The following information about common treatment options for lung cancer is provided so that you can begin your discussion of your options with your treatment team.

Surgery

The type of surgery depends on the location and size of the tumor. Depending on the kind and stage of the lung cancer, chemotherapy and/or radiation also may be given before surgery, after surgery, or both. The goal of chemotherapy/radiation before surgery is to shrink the size of a tumor so that it can be removed. The goal of chemotherapy after surgery is to destroy tiny cancer cells - those that may not even be detected by imaging tests - that have spread or may have been missed during surgery.

Visit LCA's Early Interventions Resource Center for more information.

Other Treatments

Chemotherapy – A systemic treatment, chemotherapy drugs circulate through the body to kill rapidly dividing cells, including cancer cells. Initial chemotherapy for lung cancer often includes a platinum-based drug (cisplatin or carboplatin) in combination with another chemotherapy drug (paclitaxel, docetaxel, etoposide, gemcitabine, pemetrexed, etc). For information on individual chemotherapies, managing side effects, and other valuable information, please see www.chemocare.com.

Targeted therapies – Treatments designed to target cancer cells in more specific ways, usually involving the mechanisms that cause cancer cells to grow or divide. Current targeted therapies used for lung cancer include Tarceva, Avastin, and Erbitux.   

Radiation Therapy – The goal of radiation therapy may be to kill or shrink cancer cells at the site of the tumor; for palliative care, such as to relieve pain; or to prevent cancer from spreading to the brain, as in prophylactic cranial irradiation after treatment for small cell lung cancer.

• External beam radiation (external beam): Use of carefully aimed doses of radiation at specific sections of the lungs or surrounding areas (such as the neck or center of the chest). For more information: http://www.radiologyinfo.org/en/info.cfm?PG=ebt
• Brachytherapy (internal or implant radiation therapy): Radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. For more information: http://www.radiologyinfo.org/en/info.cfm?PG=brachy
• Intensity Modulated Radiation Therapy (IMRT): A type of conformal radiation, which means the beams of radiation are shaped to closely match the shape of the tumor, sparing more normal tissue surrounding the tumor than general radiation. IMRT allows more radiation to be delivered directly to the tumor, as the intensity of the radiation can be changed throughout treatment. IMRT is only available with linear accelerated based machines, the most well-known is Tomotherapy®. For more information: http://www.irsa.org/imrt.html
• Stereotactic Radiosurgery (SRS or STRS)
• There are three kinds of SRS, and each uses a different kind of machine that operates in a different way, and with a different source of radiation. SRS is a one-day session with a single high dose of radiation but some machines can also be used for “fractionated” radiation, that which is done over time.
• Particle beam (proton)—only exist in a handful of centers in the US, see New and Emerging Treatments page for further details.
• Cobalt 60 based (photon)—the most well known machine is Gamma Knife®, which is designed exclusively for brain tumors. Used for brain metastases from lung cancer.
• Linear accelerated based (linac)—the most well-known machines are Novalis Tx® and CyberKnife®.  For more information, see http://www.radiologyinfo.org/en/info.cfm?PG=stereotactic

• Whole brain radiation:  External radiation therapy to the head. Generally used to treat brain metastases from lung cancer
• PCI (Prophylactic Cranial Irradiation):  Radiation to the head with the goal of reducing the risk of brain metastases. It is commonly recommended after successful treatment for small cell lung cancer

Photodynamic Therapy (PDT) - PDT is procedure in which a special chemical is injected into the blood stream. The chemical is absorbed by all the cells but does not stay in normal cells long. It remains in cancer cells quite awhile and a laser aimed at the cancer activates the chemical to kill the cancer cells. At this time, PDT is approved for relief of symptoms (such as breathing problems or bleeding) in non-small cell lung cancer and can also treat small tumors.

Ablation Therapies

• Radiofrequency Ablation (RFA): uses radio waves to heat up needles which are inserted into tumors and destroys them. For more information visit http://www.radiologyinfo.org/en/info.cfm?pg=rfalung]

• Cryoablation: Uses liquid nitrogen or argon gas to freeze tumors. Approved for treatment of other cancers, in clinical trials for lung cancer. For more information: http://www.radiologyinfo.org/en/info.cfm?pg=cryo

For more information about all lung cancer treatment, please visit the National Cancer Institute’s website:
http://cancernet.nci.nih.gov/cancertopics/treatment/lung