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early stage lung cancer

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #14 Treating Early Stage Small Cell Lung Cancer

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GRACE Cancer Video Library - Lung

 

For our 14th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers.  In this video Dr. Hunis speaks about treating early stage small cell lung cancer.  


 

 

 

 


 

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TRANSCRIPTS – Spanish and English
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Tratamiento para el Cáncer de Pulmón de Células Pequeñas en Estadio Temprano

El tratamiento de cáncer de pulmón de células pequeñas en estadios limitados al pulmón, probablemente al mediastino, y no se ha esparcido a ninguna parte del cuerpo, está hecho con fines curativos. Por lo cual uno hace todo lo posible para tratar de eliminar ese tumor. Por lo general, rara vez esos tumores se operan y en cambio se tratan con una combinación de quimioterapia y de radioterapia. Se hacen quimioterapia en conjunto con radioterapia. Una vez que la radioterapia se completa, por lo general un mes y medio después, se hace quimioterapia en consolidación.

Hace unos años había un estudio muy grande que demostró también que en pacientes que terminaron su tratamiento de quimioterapia-radioterapia y que no han tenido ningún tipo de evidencia de enfermedad en estudios de seguimiento o de pesquisa, esos pacientes son buenos candidatos para hacer radioterapia al cerebro, inclusive en ausencia de enfermedad, de forma profiláctica y eso tiene una disminución hasta del 30% de riesgo de enfermedad metastásico en el sistema nervioso central.


Treatment for Small Cell Lung Cancer in Early Stage

The treatment for small cell lung cancer in early stage that is limited to the lung, probably to the mediastinum and hasn’t gone into other parts of the body, its done with healing effects. So, we do everything that is possible in trying to eliminate that tumor. In general, these tumors are not surgically removed because they are treated with a combination of chemotherapy and immunotherapy. Once the radiotherapy is completed, in about a month and a half later, we do consolidation chemotherapy.

Many years ago, a big clinical trial proved that in patients that finish their chemotherapy-radiotherapy treatment and have not had evidence of disease in the inquest studies, will be good candidates for brain chemotherapy. Even in the absence of disease, as a prophylactic method, this treatment will reduce in 30% the risk of metastatic disease in the central nervous system.


GRACE Video

SBRT as a Potential Alternative for Fit Patients with Early Stage Lung Cancer

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GRACE Cancer Video Library - Lung

GCVL_LU-D09_SBRT_Alternative_Early_Stage_Lung_Cancer

 

Dr. Jeffrey Bradley, Radiation Oncologist at Washington University in St. Louis, provides evidence for the use of stereotactic body radiation therapy as an alternative to surgery for operable early stage lung cancer.

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There has been a growing interest in stereotactic body radiation therapy in the United States and across the world. As patients have come to learn about this, they have sought alternatives to surgery today. Now, surgical techniques have improved — minimally invasive surgery has proven to be quite effective in eradicating early stage lung cancer, but there is a good alternative in stereotactic body radiation therapy, and the literature is coming out now that SBRT probably offers equivalent cure rates and equivalent outcomes to minimally invasive surgery or lobectomy for early stage lung cancer.

The best example of that is a randomized trial published in The Lancet Oncology this past May. It was a randomized trial from two centers, or two groups, one in the United States — an Accuray trial comparing lobectomy to radiosurgery or stereotactic body radiation therapy. The second trial was in the Netherlands, the ROSEL trial, and it also compared patients with lobectomy to stereotactic radiation therapy. Neither trial was able to meet its accrual goals — both under-accrued and were closed due to lack of accrual. So, taken individually, these trials couldn’t give us the answer about this comparison, but the authors and the groups decided to combine the data and publish the data, and the data indicate that SBRT, in this series, proved superior to surgery in this population.

This has caused quite a controversy today. Needless to say, I think stereotactic radiation therapy does offer a reasonable alternative to surgery. Other trials are needed to prove that this is the case since that trial was underpowered to show a true difference, although it does indicate that SBRT is at least equivalent and should be considered for these patients.


GRACE Video

Pre-Operative/Neoadjuvant Therapy: Rationale and Indications

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GRACE Cancer Video Library - Lung

GCVL_LU-D10_Lung_Cancer_Neoadjuvant_Therapy

 

Thoracic Surgeon Dr. Eric Vallieres reviews the principle of giving chemotherapy prior to lung cancer surgery in order to improve survival and potentially make it possible to do a smaller lung surgery.

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Another topic that is of interest is the fact that, since 2004, we now know that there is a rule to treat individuals after surgery with chemotherapy, that’s called adjuvant chemotherapy, if they had evidence of nodal metastases in the specimen that was removed. So, if they were stage 2 or stage 3 tumors, we now have a fair amount of data to support that these individuals should be considered for chemotherapy after surgery, or adjuvant chemotherapy.

There’s more of a debate for the stage 1b tumors, which have not spread to lymph nodes, but some of those can be fairly sizable, and at around 4 cm it’s worth a discussion that maybe tumors that are 4 cm or larger, even if the lymph nodes are not involved, maybe these individuals should be considered for chemotherapy, but that’s a topic by itself.

The advantage of adding chemotherapy after surgery is statistically real, and we’ve had four trials, two in North America and two in Europe, that have shown this, but the advantage is not… In baseball terms, it’s not a home run — it’s a single, maybe a double, but it’s real. So, I think it’s reasonable to tell your patients that if you’re going to have chemotherapy after surgery, in those situations, you can expect a 5%, as high as a 14, so between 5 and 14%, improvement in your odds of curing the cancer by adding chemotherapy. Chemotherapy should be three or four cycles of treatment after surgery, with cisplatin being one of the agents.

Now, one of the debates or questions is, why couldn’t we give the chemotherapy before surgery? Why do we have to do it after surgery? Well, that’s a topic that was very close to my heart for years, and we actually were studying this concept of giving chemotherapy before surgery at a time where the data to support post-operative chemotherapy became the standard of care, and as a result of that, almost everywhere, we stopped studying the concept of giving chemotherapy upfront. There are potential, theoretical advantages of giving the chemotherapy upfront, before surgery, and that’s called induction chemotherapy.

GCVL_LU-D10_Lung_Cancer_Neoadjuvant_Therapy 1a ML.001

The first one is that you, potentially, may control the micro-metastatic disease, the little cells that are floating around, early on, before it’s too late. You may potentially take a tumor that’s fairly large, shrink it down, and allow you to do less than a major resection — maybe you do a lobectomy instead of a pneumonectomy, but that’s debatable. You have an idea of whether your drugs are working because you can follow the tumor on x-ray or PET scan to see if the tumor is shrinking as a response to chemotherapy, which is potentially an advantage to the oncologist, particularly when the chemotherapy is a little hard on the patients, because once you do your chemotherapy after surgery, the x-rays are now normal, there’s no tumor around, so we’re doing it, but it’s kind of a shot in the dark because you can’t see whether the tumor is responding or not.

The final potential advantage is that there may be more easiness in giving the chemotherapy before surgery, because that has always been a bit of an issue when you’re trying to give it after surgery, your intentions are there, the patients start it, but they’re still recovering from surgery, and you’re not able to give it. So maybe, what we call, the delivery of chemotherapy, may be in the 70-75% range after surgery at best, and if you give it before surgery, it’s probably 10-15 points higher. Whether or not that translates into better results, we don’t know right now.

GCVL_LU-D10_Lung_Cancer_Neoadjuvant_Therapy 1a ML.002

So these are advantages, and the fact is that, when we look at the studies that were done studying the question of induction chemotherapy, and we group them all together, we come up with what’s called a hazard ratio, which evaluates the effect of your treatment, very, very similar to the hazard ratio of giving the chemotherapy after surgery. So, there are those who believe that these two strategies are very equivalent. There are those who also believe that maybe, actually, induction is a little bit better, but right now it’s a subject of debate.


GRACE Video

Will Erlotinib Prevent Disease Recurrence in Patients with Early Stage EGFR Positive Non-small Cell Lung Cancer?

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Dr. Joel Neal of Stanford University Medical Center discusses the SELECT clinical trial which studied early stage non-small cell lung cancer patients and whether or not Tarceva (erlotinib) would prevent disease recurrence. February 2014.


GRACE Video

An Update on ECOG 1505: Will Avastin (Bevacizumab) Become Standard Treatment for Early Stage Lung Cancer Patients?

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Dr. Heather Wakelee of Stanford University Medical Center talks about how studies looking into Avastin (bevacizumab) for early stage lung cancer patients are progressing. February 2014.


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