Therapy according to tumor type and stage
Therapy of small cell lung carcinoma
Because of its rapid growth, the metastases that are usually already present at diagnosis, and because of the good response to chemotherapy, it is the first-line treatment for small-cell bronchial carcinoma. If the tumor is limited to one lobe of the lung (“limited disease”), simultaneous radiotherapy or surgical therapy (curative tumor resection) may be considered as a complementary option.Stage T1-2 N0-1 M0
In this still limited stage, primary surgery (lobectomy (surgical removal of a lobe of the lung)/curative tumor resection with mediastinal lymphadenectomy/lymph node removal) can be performed, although it is not routinely recommended. This should be followed by adjuvant chemotherapy. Similarly, postoperative radiotherapy is recommended.In case of complete remission: prophylactic cranial irradiationStage T2-4 N2-3 M0.
If the tumor is already more advanced, chemotherapy is started immediately after diagnosis. This is followed by radiotherapy.
Stage T1-4 N1-3 M1
Chemotherapy is the first-line treatment, and simultaneous radiation therapy may also be given as a supplement.
Therapy of non-small-cell bronchial carcinoma
The following is the further therapy based on stage:Stage T1-2 N0 M0.
Curative surgery (lobectomy (surgical removal of a lobe of the lung)/curative tumor removal with mediastinal lymphadenectomy) can be performed at this stage.If the tumor is inoperable, radiotherapy is possible.
Stage T1-3 N0-1 M0
If the tumor is operable, surgery is performed followed by radiation therapy. If surgery is not possible, radiotherapy is performed immediately.
Stage T1-3 N1-2 M0
If the tumor is inoperable, radiation/chemotherapy is performed.
If only one lymph node station is affected, surgery is performed followed by radiotherapy.
If several lymph node stations are already affected, radiation/chemotherapy is performed first, followed by surgical therapy with subsequent radiation therapy.
Stage T4 N0-3 M0
Surgery is possible in combination with subsequent radiotherapy.
However, if lymph node metastases are already present, radiotherapy is often the treatment of choice; primary surgery is only possible in about 25-30% of patients in this case.
In the advanced N2 stage, chemotherapy or radiation/chemotherapy followed by surgery has proven effective.
Stage T1-4 N1-3 M1
If metastases are already present, the following therapies may be considered:
- Chemotherapy
- Palliative radiotherapy and bisphosphonates.
- Surgery of individual metastases
- Endoscopic removal of metastases
Assessment of functional operability by absolute one-second capacity
| Absolute one-second capacity [l], preoperative | Operability |
| > 2,5 | Sufficient for pneumectomy (removal of one lung lobe) |
| 1,75 | Sufficient for lobectomy (removal of one lobe of the lung) |
| 1,5 | Sufficient for segmental resection (partial lung removal) |
| < 0,8 | Inoperable |