Treatment of bronchogenic carcinoma

Here, we will discuss the different approaches to management (treatment) and control of bronchogenic carcinoma which include Surgical resection of the tumor , Radiotherapy , Chemotherapy and Laser therapy .

I) Surgery : 

* Surgical resection is the therapy of choice for patients with non small cell carcinoma who are operable candidates.
* (5-10% of cases are suitable for resection and about 70% survive for 5 years)
Criteria of operability:
• When the tumor is confined to the lung
• Away from carina by > 2 cm
• Good lung functions.
• No distant or localized spread
===> Pneumonectomy + irradiation .

II) Radiotherapy:

(A) Radiation therapy for cure:
* High dose radiotherapy can produce results that are as good as those of surgery in patients who have slowly growing squamous carcinoma.
* Radiation therapy is the treatment of choice if the tumour is inoperable, poor lung function is a relative contraindication.

(B) Symptomatic radiation treatment:
* It is used for bone pains and haemoptysis and also to decrease SVC obstruction.

III) Chemotherapy:

* Small cell carcinoma (chemosensitive)
- Combination of cisplatin and etoposide may increases the survival at 5 years from 15% to 25%, cranial radiation can be combined with chemotherapy, this particularly efficient at preventing brain metastasis, this is because small cell carcinoma frequently metastasizes to the brain.
* Non small cell carcinoma
- Trials of cisplatin based combination chemotherapy can improve the 5- years survival.
Radiotherapy also can be combined with chemotherapy.

IV) Laser therapy

 endobronchial irradiation and tracheobronchial stents:
(A) Lasser passed through a bronchoscope can be used to vaporize inoperable fungating intraluminal occluding carcinoma.
(B) Endobronchial irradiation (brachytherapy) for intraluminal tumour and malignant extrinsic compression.
(C) Tracheobronchial stents (made of silicone) for strictures caused by the tumour or from external compression.
Important articles to read : 
• Manifestations of Bronchogenic carcinoma (clinical picture)
Treatment of bronchogenic carcinoma
Dr.Tamer Mobarak


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