Treatment Option Overview for NSCLC
In NSCLC, results of standard treatment are poor except for the most localized cancers. All newly diagnosed patients with NSCLC are potential candidates for studies evaluating new forms of treatment.
Surgery is the most potentially curative therapeutic option for this disease. Postoperative chemotherapy may provide an additional benefit to patients with resected NSCLC. Radiation therapy combined with chemotherapy can produce a cure in a small number of patients and can provide palliation in most patients. Prophylactic cranial irradiation (PCI) may reduce the incidence of brain metastases, but there is no evidence of a survival benefit and the effect of PCI on quality of life is not known.[1,2] In patients with advanced-stage disease, chemotherapy offers modest improvements in median survival, though overall survival is poor.[3,4]
Chemotherapy has produced short-term improvement in disease-related symptoms. Several clinical trials have attempted to assess the impact of chemotherapy on tumor-related symptoms and quality of life. In total, these studies suggest that tumor-related symptoms may be controlled by chemotherapy without adversely affecting overall quality of life;[5,6] however, the impact of chemotherapy on quality of life requires more study. In general, medically fit elderly patients with good performance status obtain the same benefits from treatment as younger patients.
The standard treatment options for each stage of NSCLC are presented in Table 8.
Table 8. Standard Treatment Options for NSCLC
|Stage (TNM Staging Criteria)||Standard Treatment Options |
|Stage 0 NSCLC ||Surgery |
|Stage I NSCLC ||Surgery|
|Stage II NSCLC ||Surgery|
|Stage IIIA NSCLC||Resected or resectable disease||Surgery|
|Unresectable disease||Radiation therapy|
|Superior sulcus tumors||Radiation therapy alone|
|Radiation therapy and surgery|
|Concurrent chemotherapy with radiation therapy and surgery|
|Surgery alone (for selected patients)|
|Chest wall tumors||Surgery|
|Surgery and radiation therapy|
|Chemotherapy combined with radiation therapy and/or surgery|
|Stage IIIB NSCLC||Sequential or concurrent chemotherapy and radiation therapy|
|Chemotherapy followed by surgery (for selected patients)|
|Radiation therapy alone|
|Stage IV NSCLC||Cytotoxic combination chemotherapy|
|Combination chemotherapy with bevacizumab or cetuximab|
|Epidermal growth factor receptor tyrosine kinase inhibitors (for patients with EGFR mutations)|
|Maintenance therapy following first-line chemotherapy|
|External-beam radiation therapy (for palliation) |
|Endobronchial laser therapy and/or brachytherapy (for obstructing lesions) |
|Recurrent NSCLC||Radiation therapy (for palliation)|
|Surgery (for isolated cerebral metastasis in highly selected patients)|
|Laser therapy or interstitial radiation therapy (for endobronchial lesions)|
|Stereotactic radiation surgery (for highly selected patients)|
In addition to the standard treatment options presented in Table 8, treatment options under clinical evaluation include the following:
- Combining local treatment (surgery).
- Regional treatment (radiation therapy).
- Systemic treatments (chemotherapy, immunotherapy, and targeted agents).
- Developing more effective systemic therapy.