CANCER TREATMENT IN THE LUNGS ( Surgery on Lung Cancer, Radiotherapy, Chemotherapy, Gene Therapy )

Lung cancer treatment is combined modality therapy (multi-modaliti therapy). In fact at the time of selection of treatment, often not only expected to histologic type, degree and appearance of the patient but also the condition of non-medisseperti owned facilities for hospital patients and the economy is also a factor that was crucial.  

Surgery on lung cancer

Indications of surgery in lung cancer is to KPKBSK stage I and II. Surgery is also part of the "combine modality therapy", for example neoadjuvan chemotherapy for stage IIIA KPBKSK. Another indication is if there is distress that requires surgical intervention, such as lung cancer with vena cava syndrome superiror weight. The principle of surgery is to resect the tumor as much as possible complete the following intrapulmoner KGB network, with lobectomy or pneumonectomy. Segmentektomi or wedge resection of lung physiology is only done if it is not enough for lobectomy. Edge of the incision checked with frozen cut incision to ensure that the boundary-free bronchial tumor. Mediastinal lymph nodes retrieved by a systematic dissection, and examined in anatomical pathology.  

Another important thing that is important to remember before doing surgery is knowing the patient tolerance to this type of surgery to be performed. Tolerance of patients before surgery can be measured by the value of pulmonary physiology testing and if it is not allowed can be judged from the results of blood gas analysis (AGD).

Terms for lung resection

• Mild risk for pneumonectomy, when KVP good contralateral lung, VEP1> 60% .

• Pneumonectomy moderate risk, when KVP contralateral lung> 35%, VEP1> 60%  

Radiotherapy  

Radiotherapy in lung cancer can be curative or palliative therapy. In curative therapy, radiotherapy became part of KPKBSK chemotherapy for stage IIIA neoadjuvan. In certain circumstances, radiotherapy alone is rarely a viable alternative curative therapy. Radiation is often an emergency action that should be done to alleviate complaints of the patient, such as vena cava syndrome superiror, bone pain due to chest wall tumor invasion and metastasis of tumors in bone or brain.  

Determination of radiation on KPKBSK policy determined several factors: 

1.  Staging the disease.
2. Status display.
3. lung function  

If radiation is done after surgery, then it must be known: 

• The type of surgery including lymph node dissection is done

• Assessment of the incision limits by experts Pathology (PA) Given radiation dose is generally 5000 - 6000 cGy, by providing 200 cGy / x, 5 days a week. 

Standard terms before patients are irradiated:

• Hb> 10 g% 

• Platelets> 100.000/mm3 

•  Leukocytes> 3000/dl 

Palliative radiation given to the unfavourable group, namely : 

• PS <70. 

•  Weight loss> 5% in 2 months. 

•  Poor lung function.  

Chemotherapy  

Chemotherapy can be given in all cases of lung cancer. The main requirement to be determined histologic type of tumor and appearance (performance status) should be more and 60 according to the scale Karnosfky or 2 according to the WHO scale. Chemotherapy is done by using multiple anticancer drugs in combination chemotherapy regimens. In certain circumstances, the use of an anti-cancer drugs do.  

The principle of selection and providing a type of anticancer chemotherapy regimens are:

• Platinum-based therapy (cisplatin or karboplatin) 

• Objective response of the anticancer drug's 15% 

• Toxicity of drugs does not exceed grade 3 WHO scale 

• Should be discontinued or replaced if, after giving two cycles occurred in the assessment of progressive tumor.  

Regimens to KPKBSK are: 

• Platinum-based therapy (cisplatin or karboplatin) 

• PE (cisplatin or etoposide + karboplatin) 

• Paklitaksel + cisplatin or karboplatin 

• Gemsitabin + cisplatin or karboplatin 

• Dosetaksel + cisplatin or karboplatin  

Standard terms that must be met before chemotherapy :

•  Display> 70-80, in patients with PS <70 or elderly, can be given the anticancer drug with specific regimens and / or specific schedule. 

• Hb> 10 g%, mild anemia in patients without acute bleeding, although Hb <10 g% do not need a blood transfusion immediately, simply given the treatment in accordance with the cause of anemia. 
• Granulocytes> 1500/mm3 

• Platelets> 100.000/mm3 5. Good liver function 6. Good renal function (creatinine clearance over 70 ml / min)  

Gene Therapy

Techniques and benefits of this treatment is still under investigation