Treatment

Treatment of Stage I and Stage II is primarily surgery.

1. Wedge Resection

2. Segmentectomy

3. Lobectomy

4. Pneumonectomy

5. Sleeve Resection

Treatment for Stage IIIA remains controversial; however induction therapy has had up to 30% of patients resectable. The remaining stages are managed primarily with radiation and chemotherapy.

Stage I carcinoma of the lung can expect 3- and 5-year survival rates of approximately 85% and 70%, respectively. The most favorable group of patients with Stage I disease, those with T 1N 0 disease, experience 5-year survival rates of 80% to 85%. Neither chemotherapy nor radiation therapy is recommended after complete resection of Stage I lung cancer.

Surgical therapy includes resection of the primary tumor with resection of the hilar, interlobar, lobar, and segmental lymph nodes. In addition, systematic medias-tinal lymph node dissection is performed to exclude the presence of mediastinal metastases. Five-year survival rates of 40% to 50% are observed with a recurrence rate of greater than 50%. Postoperative radiation therapy may reduce the incidence of local and regional recurrence but does not affect overall survival.

This is a controversial area with current recommendations of resection combined with some form of adjuvant therapy.

Stage I

Stage II

Stage IIIa

Table 19.3.

Genetic factors in lung cacner

Oncogenes

Functions

Comment

90% of lung cancers Decreased survival Increased survival when present

K-ras

HER-2

BLC-2

Tumor suppressor p53

Signal transduction Chemoresistance

Proto-oncogene inhibits apoptosis

DNA binding and cell cycle regulation

Cell cycle control and proliferation Cell cycle control and proliferation

90% of lung cancers Decreased survival Increased survival when present

Decreased survival

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