Non-small-cell lung cancer is the most common form of pulmonological oncopathology, which accounts for over 85% of clinical cases. Different subtypes of tumors require different treatment regimens, and therefore doctors conduct laboratory tests, targeted biopsy and molecular genetic testing prior to treatment start. The comprehensive diagnostics allows doctors to differentiate adenocarcinomas (40-50% of cases), squamous cell (25-40% of cases) and large cell (3-5% of cases) carcinomas. Depending on the tumor subtype and stage of the process, oncologists can perform surgical treatment, radiation therapy, chemotherapy, immunotherapy and targeted therapy.
In European countries, a therapeutic regimen for oncological lung diseases is developed by a multidisciplinary team of experts, which includes pulmonologists, surgeons, oncologists, radiologists, pathologists and psychologists. In case of small neoplasms located within one lung, surgery is preferred. Depending on the stage of the process and the type of cancer, the organ can be removed totally or partially:
- Segmentectomy and wedge resection is a procedure that involves the removal of a segment of the lung with bronchi and blood vessels. The specialized clinics perform segmental resection of a lung tumor using an endoscopic technique. Thanks to the use of miniature instruments and video cameras, video-assisted thoracoscopic surgery (VATS) is performed through incisions up to 2-3 centimeters long.
- Lobectomy is a more extensive surgical procedure that includes removal of a lobe of the lung in case of peripheral localization of a malignancy. Lobectomy can be either open or endoscopic.
- Pneumonectomy is a surgical procedure of removing the entire lung on one side. As a rule, pneumonectomy is performed using open techniques, since the surgeons remove not only a lung, but also regional lymph nodes.
Surgery can also be performed at the advanced stages of cancer. In this case, they are aimed at alleviating the symptoms of endobronchial obstruction and improving the patient's quality of life. Such interventions include cryotherapy – exposure to low temperatures. The cryoprobe is inserted into the respiratory tract, located near the neoplasm and freezes it. As a result, the tumor shrinks, which allows the patient to breathe easier.
Another option for sparing treatment of the early cancer stages is radiofrequency ablation. A probe capable of conducting radio waves is inserted into the neoplasm under the CT guidance. Due to the high energy of the radio waves, its temperature rises, which leads to the destruction of atypical tissue.
Radiation and photodynamic therapy
Radiation therapy is widely used as an alternative to surgery at the early stages of the disease, as an additional therapy after surgery, as well as a symptomatic measure in tumors blocking the respiratory tract. The doctors can also carry out conventional external irradiation of other organs, to which the oncological process has spread (for example, bones or brain).
European clinics use modernized types of radiation therapy for lung cancer aimed at the best possible irradiation of the malignant focus along with preserving the surrounding healthy tissues:
- Photodynamic therapy is based on increasing the sensitivity of cancer cells to light waves of a certain length. The patient receives an intravenous injection of a photosensitizer, which selectively accumulates in the tumor. 24-72 hours later, a catheter with a laser emitting light of the required length is brought to the tumor. The procedure is completely harmless to healthy tissues, while atypical cells are destroyed by light.
- Stereotactic ablative radiotherapy (SABR) is comparable to surgery due to the high accuracy of irradiation. The high-energy X-rays affect the neoplasm, targetedly destroying it in one or more sessions.
- Internal radiation therapy involves the implantation of a local source of radiation near the tumor. Due to the high dose of radiation, such an irradiation session lasts no more than a few minutes.
The indications for chemotherapy for lung cancer include:
- Preoperative preparation, tumor size reduction
- Prevention of relapse after surgery
- Tumor growth and progression retardation in incurable cases
- Potentiation of the effect of radiation therapy
The cancer centers provide the administration of chemotherapy drugs intravenously or using a special pump. The duration of the course depends on the stage of cancer and the type of tumor. The highest efficacy was demonstrated by cisplatin or carboplatin in combination with docetaxel, gemcitabine, paclitaxel, vinorelbine or pemetrexed.
Targeted therapy is used in patients with metastatic lesions of the liver, lymph nodes, bones, intestines and brain. The targeted drugs recognize specific targets in malignant cells and affect them specifically. Such targets are tumor proteins, as well as cellular or molecular changes, the effect on which blocks the growth and metastasizing of the tumor.
The targeted drugs are prescribed based on the results of molecular diagnostics, which determines their potential effectiveness. The molecular diagnostics is carried out in the specialized European laboratories and includes an assessment of the following:
- Mutations in the epidermal growth factor gene (EGFR)
- Alterations (transformations) of the ALK gene
- Vascular endothelial growth factor (VEGF) expression
Depending on the results, the doctors include Crizotinib, Erlotinib, Gefitinib or other drugs in the therapeutic regimen. All drugs are available in tablet form; the patient can take them at home, without a mandatory visit to the clinic. The use of targeted agents minimizes the side effects that often develop in case of systemic chemotherapy.
If molecular diagnostics does not reveal genetic disorders, the oncologists are considering the option of prescribing another type of biological therapy, namely immunotherapy. This type of treatment is based on the use of immune response checkpoint inhibitors. The immune response checkpoint inhibitors are molecules with the help of which malignant neoplasms protect themselves from the action of the immune system. With their drug suppression, the doctors activate the patient's own antitumor immunity.
The treatment of non-small-cell lung cancer involves the use of immune response checkpoint inhibitors, the action of which is directed at the programmed cell death protein (PD-1) or to its ligand (PD-L1). When planning immunotherapy, the expression of PD-L1 by tumor cells is evaluated preliminarily. The substances from this group include the humanized monoclonal antibody Pembrolizumab (Keytruda).
When prescribing another type of monoclonal antibody, namely Nivolumab (Opdivo), a preliminary analysis of the expression of PD-L1 is not performed. Nivolumab blocks both ligands, namely PD-L1 and PD-L2, thereby completely excluding the effect of PD-1 in tumor cells or its microenvironment. To date, the European Medicines Agency has approved immunotherapy for patients with advanced and metastatic cancer.
Cancer treatment abroad with Booking Health
The methods recommended by international protocols are fully available only in large or specialized hospitals. Thus, minimally invasive interventions require the purchase of expensive equipment and training of medical personnel, drugs for immunotherapy and targeted treatment must be approved at the local level, and so on. Therefore, the patients who require high-tech or innovative treatment are often looking for the opportunity to go abroad.
The Booking Health company has been organizing lung cancer treatment in the leading European clinics for over 15 years. Booking Health is a certified medical tourism operator, which will help you with the following important issues:
- Selection of the right hospital based on an annual qualification profile
- Direct communication with an attending pulmonologist or oncologist
- Preliminary preparation of a medical program
- Provision of the favorable cost of medical services, without overpricing for foreigners (saving up to 50%)
- Making an appointment for consultation or hospitalization on the desired date
- Independent control of all stages of the medical program
- Assistance in buying and forwarding of medicines
- Communication with the clinic after the treatment completion, translation of medical records
- Explaining the recommendations for further follow-up and lifestyle modifications (for example, smoking should be excluded)
- Control of invoices and return of unspent funds
- If necessary, organization of additional examinations
- Top-class service: booking hotels and apartments, tickets, transfer
Please, leave a request for treatment on the official website of Booking Health, and a competent representative of the company will contact you within 24 hours.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova