The effectiveness of treatment of lung cancer with chemotherapy. Medicines and nutrition
Lung cancer ranks first in the number of deaths among all cancers. The main risk group is elderly people, but the disease is also diagnosed in young patients.
Chemotherapy for lung cancer is the main method of fighting cancer cells. In the first two stages of the disease, chemotherapy can be combined with operations to remove tumors.
At the third stage, when cancer cells begin to metastasize, chemotherapy becomes the main focus and can be combined with radiation therapy.
A diagnosis of lung cancer means that a patient is developing tumor formations in the respiratory organs. Most often, the tumor is localized in the right lung, in its upper lobe.
Fact! The difficulty in treatment lies in the asymptomatic course of the disease in the initial stages. It is diagnosed when metastasis begins and pathogenic cells spread to other organs.
Chemotherapy treatment of lung cancer is the main method of combating this oncology. It consists of administering drugs to the patient that stop the growth of cancer cells, prevent them from dividing and ultimately destroy them completely. Drug treatment may be used as the only treatment, but in some cases it may be combined with radiation therapy or surgical removal of the tumor.
Chemistry most effectively fights small cell cancer, which is quite noticeably susceptible to the effects of drugs. The non-small cell structure of the tumor often shows resistance and a different course of treatment is selected for the patient.
The spread of cancer cells to other organs means metastasis of the disease and the occurrence of stage 4 cancer. It is not possible to fight metastases with chemotherapy. Therefore, at stage 4, drug therapy is used as palliative treatment.
Treatment process
Modern medicine has made the process of prescribing medications much more complicated. Just 10-15 years ago, everything was much simpler: a patient with oncology comes to the clinic and is prescribed one or two drugs, depending on his condition.
Treatment instructions for almost all categories of patients were the same. Neither histological results nor biological indicators were taken into account, nor the opinions of doctors from other fields of medicine were taken into account - all this did not affect the course of treatment.
At the present stage, the chemotherapy procedure for patients with lung oncology will be carried out depending on the disease itself.
Tumor indicators affecting the course of treatment:
- tumor size;
- stage of development;
- level of metastasis;
- progression and growth rate;
- place of localization.
The course of therapy is influenced by individual indicators of the body:
- age;
- general health;
- the presence of chronic pathologies;
- state of the body's immune system.
In addition to indicators of the development of oncology and the individual characteristics of the body, modern clinics take into account the cytogenetics of the tumor. Depending on this indicator, cancer patients are divided into four groups and appropriate treatment is prescribed.
Attention! Taking into account narrowly targeted indicators, coupled with the latest advances in medicine, has made it possible to significantly increase the percentage of complete recovery. It is worth noting that these statistics confirm the positive results obtained in the initial stages of tumor development.
How does chemotherapy work for lung cancer?
The course of treatment for cancer patients is adjusted by an oncologist. Individual characteristics of the body, the structure of the tumor, the stage of the disease - these factors will influence how chemotherapy is administered for lung cancer.
Treatment with medications is carried out on an outpatient basis. Medicines are taken orally or intravenously. The oncologist selects the dosage and drug for the patient, having first summed up all the factors of the disease. The tactic of combining medications is usually used. This is practiced for more effective treatment.
Drug treatment for cancer is carried out in cycles of several weeks or months. The interval between cycles is from 3 to 5 weeks. This rest is very important for a cancer patient. It allows the body and immune system to recover from chemotherapy.
There is a possibility that cancer cells will adapt to the current drugs. To avoid a decrease in the effectiveness of treatment, medications are changed. Modern pharmacology has come close to solving the problem of reducing the effect of drugs on tumor formations. The latest generations of oncology medications should not have an addictive effect.
During chemotherapy, the patient's general condition worsens and side effects occur. The attending physician must constantly monitor the patient's health. Regular examination and monitoring of vital signs is important.
The number of cycles depends primarily on the effectiveness of treatment. The most acceptable for the body is 4-6 cycles. This avoids serious deterioration in the patient's well-being.
Important! Chemotherapy procedures should be carried out in conjunction with therapy aimed at reducing side effects.
Contraindications to chemotherapy for lung cancer
Chemotherapy for lung cancer is defined as the most effective method of combating cancer. It is used when there are contraindications to other treatment methods, such as surgery. But there are a number of factors in the presence of which drug destruction of cancer cells is contraindicated.
The main list of contraindications is as follows:
- metastasis to the liver or brain;
- intoxication of the body (for example, severe pneumonia, etc.);
- cachexia (complete exhaustion of the body with weight loss);
- increased bilirubin levels (indicates active destruction of red blood cells).
To prevent harmful effects on the body, a number of studies are carried out before chemotherapy. Only after the results are obtained, a medication course is selected.
Side effects and complications
Drug treatment of a tumor is aimed at inhibiting the division of cancer cells or completely destroying them. However, along with the positive effect of such therapy, almost all patients experience many complications.
First of all, from the toxic effect of drugs, the immune system, gastrointestinal tract, and hematopoiesis are affected.
Consequences of chemotherapy for lung cancer:
- diarrhea, nausea, vomiting;
- hair loss;
- destruction of leukocytes, erythrocytes, platelets;
- addition of side infections;
- fatigue;
- nails become brittle;
- headaches and drowsiness;
- hormonal imbalance (women are especially affected).
If complications arise during treatment, you must first contact your doctor and get tested. After receiving a clinical analysis, the specialist will be able to adjust the treatment regimen.
It is worth noting that any side effects must be reported to your doctor. The doctor will be able to select symptomatic treatment. Selecting methods to combat side effects on your own is prohibited.
Drugs used in the treatment of lung cancer
Medicines whose action is aimed at fighting cancer cells have varying effectiveness and tolerability. The world's leading centers for the fight against cancer are constantly developing the latest treatment methods with greater accuracy and focus.
Chemotherapy drugs for lung cancer are used taking into account a wide range of individual patient factors. Also, medications are prescribed taking into account the degree of their impact on pathogenic cells and the stage of development of the disease.
Fixed assets are discussed in the table:
| Drug groups | Mechanism of action on cancer cells. | Active ingredients | Side effects |
| Alkating agents | They interact with DNA, resulting in mutation and cell death. |
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| Antimetabolites | They inhibit biochemical processes, causing cell growth to slow down and their functions to be impaired. |
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| Anthracyclines | They affect the DNA molecule, causing replication disruption. They have a mutagenic and carcinogenic effect on the cell. |
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| Vincaloids | It affects the protein tubulin, which is part of microtubules, and leads to their disappearance. |
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| Platinum preparations | They destroy the DNA of cancer cells and prevent their growth. |
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| Taxanes | Prevents cancer cell division |
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Modern chemotherapy provides more and more positive guarantees and is less painful for patients. At this stage of medical development, there are no antitumor drugs without side effects. A common side effect that unites almost all chemotherapy drugs is the effect on the gastrointestinal tract and hematopoietic organs.
The video in this article will familiarize readers with the features of chemotherapy and the principle of its effects.
Diet during chemotherapy
While fighting a tumor in the lungs, the patient’s body is literally exhausted. This is the price the patient pays for the destruction of cancer cells. Drug treatment is not accompanied by a special appetite. Food for the body becomes the only source of replenishment of minerals and vitamins.
Nutrition after chemotherapy for lung cancer cannot be called special. Rather, it should be balanced and healthy (pictured). Much of what the patient could afford before treatment will have to be excluded from the diet.
- canned foods;
- sweets and confectionery;
- fatty and spicy foods;
- food as a base, which may be low-quality meat (sausages, smoked meats);
- alcohol;
- coffee.
Chemotherapy has a detrimental effect on proteins in the body. Therefore, foods containing proteins should be given special attention. Such food will significantly speed up the body's recovery process.
Products that need to be included in the diet:
- containing protein - nuts, chicken, eggs, legumes;
- containing carbohydrates - potatoes, rice, pasta;
- dairy products - cottage cheese, kefir, fermented baked milk, yoghurts;
- seafood - lean fish, blue algae;
- vegetables and fruits in any form;
- Drinking plenty of fluids removes toxins from the body.
Important! Lung cancer patients undergoing chemotherapy should seek advice from a nutritionist. It is necessary to understand a very important aspect: nutrition is a very important factor influencing the general condition and speedy recovery of a cancer patient.
Prediction of survival of lung cancer patients after chemotherapy
The question of life expectancy after chemotherapy treatments is fundamental. Of course, every cancer patient hopes for a positive result.
The survival prognosis depends on many factors. But the most important of them is the stage of the disease at which the patient will be treated. The proportion is obvious - the higher the stage, the lower the survival rate and life expectancy.
Important! The likelihood of a favorable outcome may directly depend on the form of the pathology.
Small cell cancer is the most common and aggressive; the pathology of this form has a negative prognosis. Life expectancy after chemotherapy for lung cancer with this form increases approximately 5 times, but the prognosis in most cases remains unfavorable.
Only 3% of patients will live more than 5 years. The average life expectancy is from 1 to 5 years. Recurrence of cancer after chemotherapy worsens the patient's prognosis.
Non-small cell cancer is mainly treated with surgery. Chemotherapy is used after the tumor is removed. The prognosis for NCLC is more favorable - 15% of patients will live 5 years. The average life expectancy will be 3 years.
If metastasis has spread to other organs, then even the most advanced medications are powerless at stage 4 of the disease. Cancer cells are not sensitive to them and chemotherapy is carried out as a palliative treatment.
Despite all the difficulties the patient endures during chemotherapy, it is impossible to refuse it. Modern techniques can significantly prolong a person’s life and make it better. Whatever the statistical indicators for lung cancer, no one can determine exactly how long a patient will live.
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Long-term results of treatment small cell lung cancer (SLC) remain unsatisfactory (Table 10), although, according to some data, they have improved over the previous decade.
Over the past 20 years, as a result of the introduction of combined treatment methods, in particular combined chemotherapy (XT), there has been an improvement in survival outcomes with 5-year survival rates increasing from 5.2% in 1972-1981. to 12.2% in 1982-1996, the median survival rate over the same period increased from 11.8 to 18.8 months (9th World Conference on Lung Cancer, Japan, Tokyo, 2000).
Table 10. Long-term results of treatment for SCLC
One of the main treatment methods is XT using combination regimens. The surgical method is used at an early stage of the process (localized process). The importance of the surgical method in the early stages is confirmed by studying the morphological variant of the malignancy of the process and clarifying the damage to the mediastinal lymph nodes.
Radiation therapy is also a mandatory component of the treatment of a localized process. At complete regression (CR) can be used prophylactic cerebral irradiation (POBI).
Localized small cell lung cancer
In stage I of the disease, surgical treatment is used, followed by chemotherapy or chemotherapy with chest irradiation. Standard XT mode, as with non-small cell lung cancer (NSCLC), is the mode:Cisplatin IV 75-100 mg/m2 1 time per day on the 1st day against the background of overhydration and antiemetics
+
Etoposide IV drip 80-100 mg/m2 1 time per day on days 1, 2 and 34
Every 3 weeks
For a localized process, it is used in combination with radiation therapy at a total dose of 40-45 Gy, which should be carried out during the 1st or 2nd cycle.
In such patients and patients with complete remission after chemotherapy, foreign authors use POGM. Patients with small cell lung cancer (SLC) must undergo a thorough, sometimes invasive examination to clarify the stage of the disease. The results of surgical treatment of localized SCLC allow achieving good 2-year survival rates.
For localized stage II SCLC, surgery results in satisfactory local control after induction CT with radiation therapy. The presence of N2 is generally a contraindication to surgical treatment.
However, in localized small cell lung cancer with stage IIIA PR after cytoreductive XT, it is possible to include surgery and then chemotherapy and then chemotherapy in the treatment plan radiation therapy (RT). The best prognostic factor is the absence of residual tumor in the removed specimen.
According to Shepherd F.A. (2002), the 5-year survival rate of all operated patients is 25-35%:
Undergo surgery (of all patients with SCLC) - 5%;
undergo surgery after induction XT for SCLC - 75%:
Of these, 8-100% (on average 50%) undergo radical surgery;
- of these, histological complete regression - 0-37%;
5-year survival rate for all operated patients is 25-35%:
5-year survival rate for stage I small cell lung cancer - >50%;
- 5-year survival rate after XT and RT - 20-25%.
Similar results were obtained using alternating EC and CAV+RT regimens at a dose of 45 Gy.
Following modeschemotherapycan be used for SCLC:
| Treatment regimens | Drugs (iv, drip), mg/m2 | Interval, weeks |
| EP | Cisplatin 80 on day 1 + etoposide 120 on days 1, 2, 3 | 3 |
| CAE | Cyclophosphamide 1000 on day 1 + doxorubicin 45 on day 1 + etoposide 100 on days 1, 2, 3 or 1, 3, 5 | 3 |
| CAV | Cyclophosphamide 1000 on day 1 + doxorubicin 50 on day 1 + vincoistin 1.4 on day 1 | 3 |
| VICE | Vincristine 1.4 on day 1 + ifosfamide 5000 on day 1 + carboplatin 300 on day 1 + etoposide 180 on days 1 and 2 | 3 |
| CDE | Cyclophosphamide 1000 on day 1 + doxorubicin 45 on day 1 + etoposil 100 on 1.3. 5th day | 3 |
| CAM | Cyclophosphamide 1000-1500 on day 1 + doxorubicin 60 on day 1 + methotoexagt 30 on day 1 | 3 |
| AVP | Nimustine 3-2 mg/kg on day 1 + etoposide 100 on days 4, 5, 6 + cisplatin 40 on day 2. 8th days | 4-6 |
| TEP | Paclitaxel 175 on day 1 + etoposide 100 on days 1, 2, 3 + cisplatin 75 on day 1 | 3-4 |
Use of intensive XT regimens with increasing doses included in the regimens medicines (medicines), as a rule, leads to improved immediate treatment results. However, even in a tumor as sensitive to XT as SCLC, the advantage of high-dose regimens has not been proven.
The optimal duration of chemotherapy for patients with localized small cell lung cancer has not been fully clarified, but no improvement in survival was observed when the duration of treatment was increased from 3 to 6 months.
The risk of developing CNS metastases can be reduced by more than 50% by CNS irradiation at a dose of 24 Gy.
When using chemoradiation treatment, the preferred hyperfractionation regimen is:
Advanced small cell lung cancer
For advanced SCLC, the median survival is 6-12 months, 5-year survival is 2.3%. Combination chemotherapy plus radiation therapy does not improve survival compared with chemotherapy alone. However, radiation therapy is important in the palliative treatment of symptoms of both the primary tumor and metastases, especially to the brain, meninges, and bones.A meta-analysis of 7 randomized studies showed the importance of CNS irradiation in patients with PR - a decrease in relapses in the CNS, improvement in relapse-free and overall survival were reported: 3-year survival increased from 15 to 21%.
The following combination XT regimens provide similar survival:
CAV (cyclophosphamide + doxorubicin + vincristine);
CAE (cyclophosphamide + doxorubicin + etoposide);
EP (etoposide + cisplatin);
EU (etoposide + carboplatin);
CAM (cyclophosphamide + doxorubicin + ethotrexate);
ICE (ifosfamide + carboplatin + etoposide);
CEV (cyclophosphamide + etoposide + vincristine);
PET (cisplatin + etoposide + paclitaxel);
CAEV (cyclophosphamide + doxorubicin + etoposide + vincristine).
The greatest effectiveness (64.7%) against various visceral metastases is the regimen with nimustine - AVP, which turned out to be more effective against metastases in the central nervous system compared to other regimens.
For brain metastases, radiation therapy, CT, and chemoradiotherapy are used:
Of particular interest is the use of new drugs in previously untreated patients with advanced SCLC (Table 11).
Table 11. Efficacy of new drugs in previously untreated patients with advanced small cell lung cancer
New drugs are also being studied in combination chemotherapy regimens.
They include 2- and 3-component treatment regimens, as well as combinations with radiation therapy:
| Treatment regimens | Drugs (iv, drip), mg/m2 | Interval, weeks | Effect |
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Docetaxel 100 1 hour |
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23% CR |
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Paclitaxel 250 24 h + G-CSF |
|
53% OE |
| TS | Paclitaxel 175 on day 1 + carboplatin 400 on day 1 | 3-4 |
|
| TP | Docetaxel 75 on day 1 + cisplatin 75 on day 1 | 3-4 |
|
| TG | Paclitaxel 175 on day 1 + gemcitabine 1000 on days 1, 8, 15 | 4 |
|
| TEP | Paclitaxel 175 3 hours + cisplatin 80 + etoposide 80 IV on day 1, 160 orally on days 2-3 + G-CSF |
|
83% OE 22% complete regression |
| TEP | Paclitaxel 135 on day 1 + cisplatin 75 on day 1 + etoposide 80 on days 1-3 |
|
90% ME MB - 47 weeks |
| GEP | Gemcitabine 800 on days 1, 8 + etoposide 50 on days 1-5 + cisplatin 75 on day 1 |
|
54% OE 75% - untreated patients |
| IP | Irinotecan 60 on days 1, 8, 15 + cisplatin 50 on day 1 + radiation therapy 4 weeks |
|
83% OE, 30% CR, MB 14.3 months - LP 86% EE, 29% CR, MB 13 months - RP |
| CN | Carboplatin 300+ Vinorelbine 25 on days 1, 8 x 6 cycles |
|
74% OE MB - 9 months |
Some results of comparing the effectiveness of the modes:
With comparable effectiveness of the EP and TEP regimens (MB 9.84 months and 10.33 months, respectively), the toxicity of the 2nd regimen was higher;
a study of the TP regimen as the 1st line of XT advanced SCLC in previously untreated patients showed its effectiveness in 59% of patients;
data from the JCOG-9511 study (Japan) were obtained on the advantages of the IP mode compared to the standard EP scheme: MB 9.4 and 12.8, respectively; OE is 83 and 68%, respectively.
In order to clarify the results, additional studies are currently being conducted. In the therapy of SCLC, as well as in NSCLC, all new directions of drug treatment are being explored, with one main trend - from nonspecific antiproliferative drugs to targeted therapy, or what foreign authors call “targeted” therapy, aimed at specific genes, receptors, proteins and etc.
V.A. Gorbunova, A.F. Marenich, 3.P. Mikhina, O.V. Izvekova
It is a serious cancer disease, which is currently the leading cause of death in the world. The disease often affects older people, but it can also occur at a young age. Cancer of the right lung is somewhat more common than the left; the tumor predominantly develops in the upper lobe.
Causes of the disease
Surprisingly, just a hundred years ago this type of oncology was considered very rare. However, the steadily growing number of smokers has created an unprecedented surge in this form of cancer. Today, all over the world there is active promotion of a healthy lifestyle, but despite this, smoking, and therefore the constant negative impact of tobacco smoke on the lungs, remain the main reasons provoking the development of the disease. Carcinogens in polluted air also affect the occurrence of lung cancer, but to a much lesser extent compared to tobacco smoke.
Diagnostic features
Every year a huge number of people die from this form of cancer. Even in countries with the most developed healthcare systems, it is not possible to effectively combat this disease. The fact is that in the vast majority of cases, lung cancer is detected only at an inoperable stage: metastases that have spread to other organs do not provide a chance to survive. The difficulty of diagnosis is explained by the asymptomatic course of the disease; in addition, the disease is often mistaken for a completely different pathology. And yet, competent specialists, using a full range of modern diagnostic tools, can detect a tumor at an early stage; in this case, the chances of recovery are significantly increased. This terrible disease must be treated comprehensively, and lung chemotherapy is an integral part of such treatment. Let's talk about it in more detail.
What is it
Chemotherapy for lung cancer involves targeted destruction using anticancer drugs. It can be used alone or combined with radiation and surgical treatment. At stage 4, lung cancer (metastases have spread to other organs) cannot be eliminated through chemotherapy, however, this method of treatment can be used to maximize the patient’s life. Much depends on the structure of the tumor. Thus, chemotherapy will most likely be effective, since he is most sensitive to the effects of chemical drugs. But non-small cell cancer often shows resistance to these drugs, so for patients with this tumor structure, a different treatment is often chosen.
Effect on the body
And lung chemotherapy has another pattern: the drugs used have a detrimental effect not only on short-lived and rapidly dividing cancer cells, but, unfortunately, also on healthy ones. In this case, the digestive tract, blood, bone marrow, and hair roots are most affected. We’ll talk about the side effects that are inevitable when treatment with chemotherapy is carried out below. Now we’ll talk about what medications are usually used to destroy a tumor.
Chemotherapy for lung cancer
With this treatment option, more than sixty types of drugs are used. The most common antitumor drugs are cisplatin, gemcitabine, docetaxel, carboplatin, paclitaxel, vinorelbine. Often, medications are combined, for example, the combined use of paclitaxel and carboplatin, cisplatin and vinorelbine, and so on is practiced. Chemotherapy for the lungs can be given by taking drugs by mouth or intravenously. Most often, medications are administered by drip. The oncologist selects the dosage for each patient individually, based on the stage of tumor development and its structure. After completing a course of chemotherapy, there is a break in treatment for two to three weeks so that the body can recover. The courses are carried out as many as planned, but the medications are changed each time, because cancer cells very quickly and easily adapt to the toxins affecting them. Chemotherapy for lung cancer is also accompanied by treatment aimed at reducing side effects.
Complications
As already mentioned, along with the benefits that the body receives from the use of chemicals (due to the destruction and slowdown of the proliferation of cancer cells), it is also harmed. After completing the first course of treatment, patients begin to experience difficulties: they develop diarrhea, nausea, vomiting, a feeling of extreme fatigue, and may develop ulcers in the mouth. Hair falls out rapidly after chemotherapy, so many have no choice but to shave their heads. Then symptoms of suppressed hematopoiesis develop: hemoglobin and the number of leukocytes decrease, neuropathy appears, and secondary infections occur. Such side effects in patients often cause severe depression, which worsens the quality of treatment, so doctors are now actively using various methods to alleviate the condition of patients. For example, to prevent nausea, strong antiemetic medications are used, and to prevent hair loss, they are cooled before
Nutrition during this treatment
When chemotherapy is administered for lung cancer, a special diet must be followed. There is no special diet for cancer patients, but they are advised to eat foods rich in vitamins and improve bowel function. The diet should include as many vegetables, fruits as possible (they can be eaten fresh, boiled, baked, in salads, steamed) and freshly squeezed juices. All this will be an excellent source of energy for the patient. In addition, you need to eat foods containing protein (chicken, fish, cottage cheese, meat, eggs, legumes, nuts, seafood) and carbohydrates (potatoes, rice, cereals, pasta). Yogurts, dairy desserts, sweet cream, and various cheeses are also welcome. During chemotherapy you should avoid fatty and spicy foods, onions, garlic, and seasonings. It is important to drink plenty of water, especially on days you take chemical medications, as fluid helps flush out toxins from your body. With this treatment, patients' perception of smells and tastes changes, so there may be no appetite, but in no case should you starve, you need to eat often and in small portions. It should be remembered that nutrition is part of the healing process, because food gives strength for recovery.
How to endure chemotherapy easier
During chemotherapy procedures, drinking grape or apple juice helps overcome nausea, but drinking carbonated water at such moments is strictly prohibited. After eating, it is recommended to maintain a sitting position for several hours; you should not lie down, as this contributes to nausea. Chemotherapy for lung cancer will give the best results if the patient receives maximum positive emotions during this period; this is almost the main condition for a successful recovery. Conversations with loved ones, reading funny books, watching entertainment programs will help overcome negative effects. The patient also needs to take lactic bacteria; active complexes such as “Bifidophilus” or “Floradophilus” are suitable for this; by taking them, hair loss can be stopped. After completing the course of treatment, the drug “Liver 48” is prescribed; it helps restore the liver and increase hemoglobin.
Treatment results
The earlier the disease is detected, the higher the effectiveness of chemotherapy for lung cancer. Much also depends on the characteristics of the body, the qualifications of the attending physicians, and the equipment of the oncology center where the treatment is performed. Many patients associate the effectiveness of chemotherapy with the severity of side effects, but this is completely wrong. Modern oncology pays a lot of attention to combating the complications of this treatment, but there are still a lot of unfavorable ones. But we must not forget that they are all temporary and will soon disappear, and in order to subsequently be a healthy and happy person, you can endure any difficulties!
For quotation: Gorbunova V.A. Chemotherapy of lung cancer // Breast cancer. 2001. No. 5. P. 186
Russian Oncology Research Center named after N.N. Blokhin RAMS
P The problem of chemotherapy for lung cancer is one of the most important in oncology. Lung cancer ranks first in incidence among all malignant tumors in men in all countries of the world and has a steady upward trend in incidence in women, accounting for 32% and 24% of cancer mortality, respectively. In the United States, 170,000 new cases are registered annually and 160,000 patients die from lung cancer.
It is fundamentally important to divide lung cancer according to morphological characteristics into 2 categories: not small cell cancer (NSCLC) And small cell carcinoma (SCLC). NSCLC, combining squamous cell, adenocarcinoma, large cell and some rare forms (bronchioloalveolar, etc.), accounts for approximately 75-80%. The share of MRL is 20-25%. At the time of diagnosis, most patients have a locally advanced (44%) or metastatic (32%) process.
If we consider that most cases are diagnosed at an inoperable or conditionally operable stage of the tumor process, when there are metastases to the mediastinal lymph nodes, then it becomes clear how important it is chemotherapy (CT) in the treatment of this category of patients. In patients with a disseminated process, the success of chemotherapy for 25 years until 1990 made it possible to extend the median survival by 0.8-3 months in SCLC and by 0.7-2.7 months. - with NSCLC. Analyzing numerous randomized trials on the treatment of 5746 patients with SCLC in 1972-1990. and 8436 patients with NSCLC in 1973-1994. B.E.Johnson (2000) comes to the conclusion that median survival is extended to 2 months only in some studies. However, it is associated with a 22% improvement; To statistically confirm this, large groups (about 840 patients) are needed, and therefore new methods for assessing the results of phase I and II clinical trials are proposed.
Small cell lung cancer Small cell lung cancer (SCLC) is a tumor highly sensitive to chemotherapy. Treatment regimens have changed, and today several regimens have been identified as the main ones and the principles of combination treatment have been defined. At the same time, a large number of new drugs are emerging, which are gradually becoming of paramount importance in SCLC. SCLC tends to grow rapidly, progress, and metastasize. As a rule, the effectiveness of drug treatment is realized just as quickly. 2 courses of chemotherapy are sufficient to determine the sensitivity of the tumor in a particular patient. The maximum effect is usually achieved after 4 courses. In total, with effective treatment, 6 courses are carried out.
Numerous literature data on the timing and location of radiotherapy (RT) are contradictory. Most authors believe that radiation therapy should be as close as possible to chemotherapy and can be carried out either in combination simultaneously or after 2-3 courses of chemotherapy.
According to a meta-analysis, survival of patients with localized SCLC (LSCL) increases with the addition of radiation therapy to chemotherapy. But this improvement is significant if radiation therapy begins simultaneously with the 1st cycle of chemotherapy. In this case, 2-year survival increased by 20% (from 35% to 55%, p = 0.057), in contrast to when RT was administered sequentially after the 4th cycle of chemotherapy. Much attention is paid to the irradiation technique: hyperfractionation using 1.5 Gy twice a day in 30 fractions (up to 45 Gy in 3 weeks) simultaneously with the 1st cycle of the EP combination (etoposide, cisplatin) allowed to achieve 47% 2-year survival rate and 26% 5-year survival rate.
Patients with prospects for prolonged survival, i.e. those with PR require prophylactic irradiation of the brain in order to reduce the likelihood of metastasis to the brain and improve survival.
There has been a renewed increase in the involvement of surgeons in the treatment of SCLC. Early stages of the disease are treated with surgery followed by adjuvant chemotherapy. The 5-year survival rate reaches 69% for stage I, 38% for stage II and 40% for stage IIIA disease (etoposide + cisplatin was used adjuvantly).
1) etoposide + cisplatin (or carboplatin); or
2) etoposide + cisplatin + taxol,
and in the 2nd line of treatment, i.e. after resistance to first-line drugs occurs, combinations including doxorubicin can be used.
In the treatment of advanced SCLC, in studies conducted in Russia, it was shown that the combination of a new nitrosourea derivative drug Nidran (ACNU) (3 mg/kg on the 1st day for the 1st course of treatment and 2 mg/kg for subsequent cases) hematological toxicity), etoposide (100 mg/m2 on days 4, 5, 6) and cisplatin (40 mg/m2 on days 2 and 8) with repeated courses every 6 weeks is highly effective against the metastatic process. The following sensitivity was noted: liver metastases - 72% (in 8 out of 11 patients, complete effect (PR) - in 3 out of 11); in the brain - 73% (11/15 patients, PR - 8/15); adrenal glands - 50% (5/10 patients, PR - 1/10); bones - 50% (4/8 patients, CR - 1/8). The overall objective effect was 60% (PR - 5%). This combination is superior in effectiveness to others and in long-term results: the median survival (MS) was 12.7 months compared to 8.8 months when using combinations with doxorubicin. In the chemotherapy department of the Russian Cancer Research Center, this combination is used as the 1st line of chemotherapy in advanced cases as the most effective.
Murray N. (1997) proposes a combination of SODE (cisplatin + vincristine + doxorubicin + etoposide) for a common process using a once-weekly dosing regimen, which caused long-term remissions with a CF of 61 weeks and a 2-year survival rate of 30%.
In patients with LSCLC, the chemotherapy department of the Russian Cancer Research Center in the past used a combination of CAM: cyclophosphamide 1.5 g/m2, doxorubicin 60 mg/m2 and methotrexate 30 mg/m2 intravenously on the 1st day with an interval of 3 weeks between courses. Its effectiveness in combination with subsequent radiation therapy was 84% with CR in 44% of patients; CF 16.2 months and 2.5-year survival rate 12%.
In recent years, new drugs have been intensively studied: Taxol, Taxotere, Gemzar, Campto, Topotecan, Navelbine and others. Taxol in doses of 175-250 mg/m2 it was effective in 53-58% of patients, as a 2nd line - in 35% of patients. Particularly impressive results were achieved when using a combination of taxol with carboplatin - 67-82%, PR - 10-18% and with etoposide and cis- or carboplatin: effectiveness 68-100%, PR up to 56%.
For SCLC in monotherapy, effectiveness Taxotere was 26%, in combination with cisplatin - 55%.
Since 1999, the Chemotherapy Department of the Russian Cancer Research Center has been studying combination chemotherapy with Taxotere 75 mg/m2 and cisplatin 75 mg/m2 in 16 patients with SCLC (common process). The effectiveness of the combination was 50% with CR in 2 patients; the median duration of effect was 14 weeks; The median life expectancy is 10 months in patients with effect, 6 months in patients without effect. It is important to note that CR was achieved for metastases in the liver (33%), adrenal glands in 1 out of 4 patients, retroperitoneal lymph nodes in 2 out of 5 patients, and with pleural lesions in 2 out of 3 patients.
Efficiency Navelbine reaches 27%. The drug is quite promising for use in various drug combinations. Topoisomerase I inhibitor - campto ( irinotecan ) was studied in the USA in phase II. Its effectiveness was 35.3% in patients with chemotherapy-sensitive tumors and 3.7% in patients with refractory ones. Combinations with campto are effective in 49-77% of patients. Efficiency topotecan for SCLC it is 38%.
On average, the effectiveness of new drugs as 1st line of treatment is 30-50% (Table 1) and they continue to be intensively studied in combination regimens, so the possibility of changing approaches to the choice of 1st line chemotherapy in the near future cannot be ruled out.
Non-small cell lung cancerIn contrast to SCLC, non-small cell lung cancer until recently belonged to the category of tumors that were not very sensitive to chemotherapy. However, chemotherapy has been firmly introduced into the methods of treating this disease literally in the last 10 years. This happened due to published studies on the survival advantage in patients receiving chemotherapy compared with patients receiving the best symptomatic treatment (advantage in CF - 1.7 months, in 1-year survival - 10%), and due to the appearance of simultaneous 6 new effective anticancer drugs.
Along with improving treatment results, the quality of life of patients receiving chemotherapy has also improved with the introduction of platinum-containing regimens.
The multicenter randomized ECOG trial in stages IIIB and IV also demonstrated improved survival (MV - 6.8 months and 4.8 months) and quality of life in 79 patients in the taxol + best symptomatic therapy group compared with 78 patients who received only symptomatic treatment .
The standard regimen in the treatment of patients with NSCLC is replacing the EP regimen (etoposide + cisplatin). combinations of Taxol with cis- or carboplatin and Navelbine with cisplatin.
The effectiveness of new anticancer drugs varies from 11 to 36% when used as the 1st line of treatment and from 6 to 17% when used as the 2nd line (Table 2).
The main focus is currently on studying combination chemotherapy regimens with new drugs. Randomized trials comparing a new agent (navelbine, paclitaxel, or gemcitabine) in combination with cisplatin versus cisplatin alone showed a survival benefit for the combinations. Randomized trials of the new combination versus the standard (EP) demonstrated an improvement in survival for the paclitaxel and cisplatin group in one of them and a quality of life benefit in patients treated with taxol.
Thus, combinations of a new drug with cisplatin or carboplatin are promising for the treatment of advanced stages of NSCLC. Comparison of navelbine with cisplatin and paclitaxel with carboplatin showed similar results (efficacy 28% and 25%; MFS 8 months in both groups; 1-year survival 36% and 38%, respectively).
Much attention is paid to studying 3-component modes, including navelbine, taxol, gemzar with platinum derivatives in various combinations. The effectiveness of these combinations ranges from 21 to 68%, median survival is from 7.5 to 14 months, 1-year survival is 32-55%. The best results were obtained from the combination of navelbine 20-25 mg/m2, gemzar 800-1000 mg/m2 on days 1 and 8 and cisplatin 100 mg/m2 on day 1. With this regimen, the limiting toxicity was neutropenia (grade III - 35-50%).
Non-platinum combinations were also quite effective - up to 88% with docetaxel and navelbine. 6 studies of this combination show differences in dose regimens (docetaxel 60-100 mg/m2 and navelbine 15-45 mg/m2) and effectiveness - 20-88%. In 4 of them, hematopoietic growth factors were used prophylactically. CF according to the results of 2 studies was 5 and 9 months, 1-year survival rate was 24% and 35%. Summary results of combinations of new drugs without platinum derivatives were analyzed by K. Kelly (2000) (Table 2).
Newly studied agents in NSCLC include tirapazamine - a unique compound that damages cells in a state of hypoxia, the fraction of which in tumors is 12-35%, and which are difficult to treat with traditional cytostatics. A study of tirapazamine 390 mg/m2 and cisplatin 75 mg/m2 every 3 weeks in 132 patients showed good tolerability, 25% efficacy and 1-year survival of 38%. Study started oxaliplatin single and in combination regimens, as well as the drug UFT (tegafur + uracil) and multidamaging antifolate (MTA).
The importance of chemotherapy and at operable stages NSCLC. For operable stages, and especially for stages IIIA-IIIB of the disease, neoadjuvant and adjuvant chemotherapy regimens are being studied. Despite a recent meta-analysis of all randomized trials from 1965-1991, which showed a reduction in the absolute risk of death by 3% by 2 years of follow-up and by 5% by 5 years for patients receiving postoperative cisplatin-containing courses of chemotherapy, compared with only surgery, these data did not serve as a basis to consider this method standard.
Meta-analysis of meaning postoperative radiotherapy There was no survival benefit compared with surgery alone. However, there is a tendency to analyze different groups of patients separately. At stage IIIB the combination of cisplatin-containing regimens and RT has advantages over RT alone. The simultaneous combination of these types of treatment is better than sequential ones. Considering the radiosensitizing properties of new antitumor agents, the prerequisites are created for safe, effective combination therapy. The active regimen is taxol with carboplatin. Its effectiveness was 69% in stage IIIA. The use of a weekly regimen is promising: taxol 45-50 mg/m2 and carboplatin 100 mg/m2 or AUC-2 in combination with radiation therapy. New radiotherapy techniques are being developed: hyperfractionation or continued acceleration and hyperfractionation. To reduce toxicity (particularly esophagitis), new liposomal protective factors are being studied.
More careful attention is paid to the selection of patients for each type and stage of treatment. Thus, it was shown that only patients with N2 (the presence of morphologically confirmed metastases in the mediastinal lymph nodes) had improved results from postoperative RT, and for patients with N0-1 this was not confirmed.
Neoadjuvant chemotherapy with taxol (225 mg/m2) and carboplatin - AUC-6 on days 1 and 22 followed by surgery in patients with IB-II and T3N1 NSCLC caused an objective effect in 59% with a 1-year survival rate of 85%.
Various durations of postoperative regimens are being studied. Neoadjuvant chemotherapy with cisplatin 50 mg/m2 + ifosfamide 3 g/m2 + mitomycin 6 mg/m2 every 3 weeks - 3 cycles compared with surgery in 60 patients with stage IIIA, 44 of whom had involvement of the mediastinal lymph nodes, showed a significant survival advantage in group of patients with chemotherapy (CF - 26 months and 8 months, respectively). Both groups also received postoperative radiation therapy.
The combination of cyclophosphamide 500 mg/m2 on day 1 with etoposide 100 mg/m2 on days 1, 2, 3 and cisplatin 100 mg/m2 on day 1 every 4 weeks - 3 cycles before surgery was better than surgery alone ( CF 64 months and 11 months, respectively). Patients with effect received 3 additional courses after surgery.
In parallel and independently, molecular mechanisms of resistance, tubulin and gene mutations are studied depending on sensitivity to chemotherapy, relapse and survival.
Advances in biotechnology have led to the creation of agents that act at the level of specific cellular changes and control cell growth and proliferation. Currently under investigation: ZD 1839, which blocks signal transduction through epidermal growth factor receptors; monoclonal antibodies - trastuzumab (Herceptin), which inhibits tumor growth by acting on the HER 2/neu gene product, overexpression of which is present in 20-25% of lung cancer patients, blockers of epidermoid growth factors and tyrosine kinase activity, etc. . All this gives hope for an imminent future breakthrough in the treatment of lung cancer.
The list of references can be found on the website http://www.site
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In world statistics, among all malignant tumors, lung cancer ranks first in terms of mortality. The five-year survival rate for patients is 20%, meaning four out of five patients die within a few years of diagnosis.
The difficulty lies in the fact that the initial stages of bronchogenic cancer are difficult to diagnose (it cannot always be seen on conventional fluorography), the tumor quickly forms metastases, as a result of which it becomes unresectable. About 75% of newly diagnosed cases are cancer with metastatic foci (local or distant).
Treatment of lung cancer is a pressing problem throughout the world. It is the dissatisfaction of specialists with the results of treatment that motivates them to search for new methods of influence.
Main directions
The choice of tactics directly depends on the histological structure of the tumor. Basically, there are 2 main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), which includes adenocarcinoma, squamous cell and large cell cancer. The first form is the most aggressive and forms metastatic foci early. Therefore, in 80% of cases, drug treatment is used. With the second histological option, the main method is surgical.
Operation. Currently, it is the only radical option for influence.
Chemotherapy.
Targeted and immunotherapy. Relatively new treatment methods. Based on targeted, precise influence on tumor cells. Not all lung cancers are eligible for this treatment, only certain types of NSCLC with certain genetic mutations are.
Radiation therapy. It is prescribed to patients for whom surgery is not indicated, as well as as part of a combined method (preoperative, postoperative irradiation, chemoradiotherapy).
Symptomatic treatment is aimed at alleviating the manifestations of the disease - cough, shortness of breath, pain and others. It is used at any stage, it is the main one in the terminal stage.
Surgical intervention
Surgical treatment is indicated for all patients with non-small cell lung cancer from stages 1 to 3. With SCLC from 1st to 2nd stage. But, given the fact that the detection rate of neoplasms at an early stage of development is extremely low, surgical intervention is performed in no more than 20% of cases.
Main types of operations for lung cancer:
- Pulmonectomy – removal of the entire organ. The most common surgical treatment option, performed when the tumor is centrally located (with damage to the main bronchi).
- Lobectomy – removal of a lobe, the indication is the presence of a peripheral formation emanating from small airways.
- Wedge resection – removal of one or more segments. It is performed rarely, more often in weakened patients and in cases of benign neoplasms.
Contraindications for surgery:
- Presence of distant metastases.
- Severe general condition, decompensated concomitant diseases.
- Chronic lung pathologies with existing respiratory failure.
- The tumor is located close to the mediastinal organs (heart, aorta, esophagus, trachea).
- Age over 75 years.
Before the operation, the patient is prepared: anti-inflammatory, restorative treatment, correction of violations of the basic functions of the body.
The operation is often performed using the open method (thoracotomy), but it is possible to remove a lobe of the organ through thoracoscopic access, which is less traumatic. Regional lymph nodes are also removed along with the lung tissue.
Adjuvant chemotherapy is usually given after surgery. It is also possible to perform surgical treatment after preoperative (neoadjuvant) chemoradiotherapy.
Chemotherapy
According to WHO, chemotherapy for lung cancer is indicated for 80% of patients. Chemotherapy drugs are drugs that either block the metabolism of tumor cells (cytostatics) or directly poison the tumor (cytotoxic effects), as a result of which their division is disrupted, the carcinoma slows down its growth and regresses.
For the treatment of malignant lung tumors, platinum drugs (cisplatin, carboplatin), taxanes (paclitaxel, docetaxel), gemcitabine, etoposide, irinotecan, cyclophosphamide and others are used as the first line.
For the second line - pemetrexed (Alimta), docetaxel (Taxotere).
Combinations of two drugs are usually used. Courses are conducted at intervals of 3 weeks, the number is from 4 to 6. If 4 courses of first-line treatment are ineffective, second-line regimens are used.
Treatment with chemotherapy for more than 6 cycles is not advisable, since their side effects will prevail over the benefits.
Goals of chemotherapy for lung cancer:
- Treatment of patients with an advanced process (stages 3-4).
- Neoadjuvant preoperative therapy to reduce the size of the primary lesion and influence regional metastases.
- Adjuvant postoperative therapy to prevent relapse and progression.
- As part of chemoradiation treatment for inoperable tumors.
Different histological types of tumors have different responses to drug exposure. For NSCLC, the effectiveness of chemotherapy ranges from 30 to 60%. In SCLC, its effectiveness reaches 60-78%, with 10-20% of patients achieving complete regression of the tumor.
Chemotherapy drugs act not only on tumor cells, but also on healthy ones. Side effects from such treatment are usually unavoidable. These are hair loss, nausea, vomiting, diarrhea, inhibition of hematopoiesis, toxic inflammation of the liver and kidneys.
Such treatment is not prescribed for acute infectious diseases, decompensated diseases of the heart, liver, kidneys, or blood diseases.
Targeted therapy
This is a relatively new and promising method for treating tumors with metastases. While standard chemotherapy kills all rapidly dividing cells, targeted drugs selectively act on specific target molecules that promote the proliferation of cancer cells. Accordingly, they are devoid of those side effects that we observe in the case of conventional schemes.
However, targeted therapy is not suitable for everyone, but only for patients with NSCLC in the presence of certain genetic mutations in the tumor (no more than 15% of the total number of patients).
This treatment is used in patients with stages 3-4 cancer more often in combination with chemotherapy, but it can also be used as an independent method in cases where chemotherapy is contraindicated.
The EGFR tyrosine kinase inhibitors gefinitib (Iressa), erlotinib (Tarceva), afatinib, and cetuximab are currently widely used. The second class of such drugs are inhibitors of angiogenesis in tumor tissue (Avastin).
Immunotherapy
This is the most promising method in oncology. Its main task is to strengthen the body’s immune response and force it to fight the tumor. The fact is that cancer cells are susceptible to various mutations. They form protective receptors on their surface that prevent them from being recognized by immune cells.
Scientists have developed and continue to develop drugs that block these receptors. These are monoclonal antibodies that help the immune system defeat foreign tumor cells.
Radiation therapy
Ionizing radiation treatment is aimed at damaging the DNA of cancer cells, causing them to stop dividing. For such treatment, modern linear accelerators are used. For lung cancer, external beam radiation therapy is mainly performed, when the radiation source does not come into contact with the body.
Radiation treatment is used for patients with both localized and advanced lung cancer. At stages 1-2, it is performed in patients with contraindications to surgery, as well as in inoperable patients. It is often performed in combination with chemotherapy (simultaneously or sequentially). Chemoradiation is the main method in the treatment of localized small cell lung cancer.
For brain metastases of SCLC, radiation therapy is also the main treatment method. Radiation is also used as a way to relieve symptoms of compression of the mediastinal organs (palliative irradiation).
The tumor is first visualized using CT, PET-CT, and marks are applied to the patient’s skin to direct the rays.
Images of the tumor are loaded into a special computer program, and treatment criteria are formed. During the procedure, it is important not to move and hold your breath at the doctor’s command. Sessions are held daily. There is a hyperfractional intensive technique, when sessions are carried out every 6 hours.
The main negative consequences of radiation therapy: the development of esophagitis, pleurisy, cough, weakness, difficulty breathing, and rarely, skin damage.
The CyberKnife system is the most modern method of radiation treatment of tumors. It can act as an alternative to surgery. The essence of the method is a combination of precise control over the location of the tumor in real time and the most accurate irradiation of it with a robot-controlled linear accelerator.
The impact occurs from several positions, the radiation flows converge in the tumor tissue with millimeter precision, without affecting healthy structures. The effectiveness of the method for some tumors reaches 100%.
The main indications for the CyberKnife system are stage 1-2 NSCLC with clear boundaries up to 5 cm in size, as well as single metastases. You can get rid of such tumors in one or several sessions. The procedure is painless, bloodless, and is performed on an outpatient basis without anesthesia. This does not require strict fixation and breath holding, as with other irradiation methods.
Principles of treatment of non-small cell lung cancer
Stage 0 (intraepithelial carcinoma) – endobronchial excision or open wedge resection.
- I Art. - surgical treatment or radiation therapy. Segmental resection or lobectomy with excision of mediastinal lymph nodes is used. Radiation treatment is carried out for patients with contraindications to surgery or who refuse it. Stereotactic radiotherapy provides the best results.
- II Art. NSCLC – surgical treatment (lobectomy, pneumonectomy with lymphadenectomy), neoadjuvant and adjuvant chemotherapy, radiation therapy (if the tumor is inoperable).
- III Art. – surgical removal of resectable tumors, radical and palliative chemoradiotherapy, targeted therapy.
- IV Art. – combination chemotherapy, targeted, immunotherapy, symptomatic radiation.
Principles of treatment of small cell lung cancer by stage
To better define treatment approaches, oncologists divide SCLC into the localized stage (within one half of the chest) and the extensive stage (which has spread beyond the localized form).
For a localized stage the following is used:
- Complex chemoradiotherapy followed by prophylactic irradiation of the brain.
Platinum drugs are most often used for chemotherapy in combination with etoposide (EP regimen). 4-6 courses are carried out with an interval of 3 weeks. - Radiation treatment given simultaneously with chemotherapy is considered preferable to their sequential use. It is prescribed with the first or second course of chemotherapy.
- The standard irradiation regimen is daily, 5 days a week, 2 Gy per session for 30-40 days. The tumor itself, the affected lymph nodes, and the entire volume of the mediastinum are irradiated.
- The hyperfractionated regime is two or more irradiation sessions per day for 2-3 weeks.
- Surgical resection with adjuvant chemotherapy for stage 1 patients.
With proper and complete treatment of localized SCLC, stable remission is achieved in 50% of cases.
For advanced stage SCLC, the main method is combination chemotherapy. The most effective regimen is EP (etoposide and platinum), but other combinations can be used.
- Radiation is used for metastases in the brain, bones, adrenal glands, and also as a method of palliative treatment for compression of the trachea and superior vena cava.
- If chemotherapy has a positive effect, prophylactic cranial irradiation is performed; it reduces the incidence of brain metastases by 70%. Total dose – 25 Gy (10 sessions of 2.5 Gy).
- If after one or two courses of chemotherapy the tumor continues to progress, it is not advisable to continue it, the patient is recommended only symptomatic treatment.
Antibiotics for lung cancer
In patients with lung cancer, there is a decrease in local and general immunity, as a result of which bacterial inflammation can quite easily occur in the altered lung tissue - pneumonia, which complicates the course of the disease. At the stage of treatment with cytostatics and radiation, activation of any infection is also possible, even opportunistic flora can cause a serious complication.
Therefore, antibiotics for lung cancer are used quite widely. It is advisable to prescribe them taking into account bacteriological examination of the microflora.
Symptomatic treatment
Symptomatic treatment is used at any stage of lung cancer, but at the terminal stage it becomes the main treatment and is called palliative. This treatment is aimed at alleviating the symptoms of the disease and improving the patient’s quality of life.
- Cough relief. A cough in lung cancer can be dry, hacking (it is caused by irritation of the bronchi by a growing tumor) and wet (with concomitant inflammation of the bronchi or lung tissue). For a dry cough, antitussives (codeine) are used, and for a wet cough, expectorants are used. Warm drinks and inhalations with mineral water and bronchodilators through a nebulizer also relieve coughs.
- Reduced shortness of breath. For this purpose, aminophylline preparations, inhaled bronchodilators (salbutamol, berodual), corticosteroid hormones (beclomethasone, dexamethasone, prednisolone and others) are used.
- Oxygen therapy (inhalation of a breathing mixture enriched with oxygen). Reduces shortness of breath and symptoms of hypoxia (weakness, dizziness, drowsiness). With the help of oxygen concentrators, oxygen therapy can be performed at home.
- Effective pain relief. The patient should not experience pain. Analgesics are prescribed according to the scheme of strengthening the drug and increasing the dose, depending on their effect. They start with non-steroidal anti-inflammatory drugs and non-narcotic analgesics, then it is possible to use weak opiates (tramadol), and gradually move on to narcotic drugs (promedol, omnopon, morphine). The analgesic groups of morphine also have an antitussive effect.
- Removing fluid from the pleural cavity. Lung cancer is often accompanied by effusion pleurisy. This aggravates the patient’s condition and worsens shortness of breath. The fluid is removed by thoracentesis - a puncture of the chest wall. To reduce the rate of fluid reaccumulation, diuretics are used.
- Detoxification therapy. To reduce the severity of intoxication (nausea, weakness, fever), infusion support is provided with saline solutions, glucose, metabolic and vascular drugs.
Hemostatic agents for bleeding and hemoptysis. - Antiemetic drugs.
- Tranquilizers and neuroleptics. They enhance the effect of analgesics, reduce the subjective feeling of shortness of breath, relieve anxiety, and improve sleep.
Conclusion
Lung cancer is a disease in most cases with a poor prognosis. However, it can be treated at any stage. The goal can be either complete recovery or slowing the progression of the process, relieving symptoms and improving quality of life, as with any chronic disease.
