Treatment options for non-small-cell lung cancer
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Non-small-cell lung cancer is the most common form of pulmonological oncopathology and accounts for over 85% of clinical cases. Different subtypes of tumors require different treatment regimens, and therefore, doctors conduct laboratory tests, targeted biopsies, and molecular genetic testing prior to starting treatment. 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 the stage of the process, oncologists can perform surgical treatment, radiation therapy, chemotherapy, immunotherapy, and targeted therapy.
Content
- Surgical treatment
- Radiation and photodynamic therapy
- Chemotherapy
- Targeted therapy
- Immunotherapy
- Cancer treatment abroad with Booking Health
Surgical treatment
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 cases with 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:
- A segmentectomy and wedge resection is a procedure that involves the removal of a segment of the lung with the bronchi and blood vessels. The specialized clinics perform a 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 that are 2-3 centimeters long.
- A lobectomy is a more extensive surgical procedure that includes the removal of a lobe of the lung in cases with peripheral localization of a malignancy. A lobectomy can be either open or endoscopic.
- A pneumonectomy is a surgical procedure that removes the entire lung on one side. As a rule, a pneumonectomy is performed using open techniques, since the surgeons remove not only a lung, but also the regional lymph nodes.
Surgery can also be performed at the advanced stages of cancer. In this case, it is 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 as a sparing treatment for the early stages of cancer is radiofrequency ablation. A probe capable of conducting radio waves is inserted into the neoplasm under 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. 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, which are aimed at the maximum 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 the 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.
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Chemotherapy
The uses of 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.
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 is demonstrated by cisplatin or carboplatin in combination with docetaxel, gemcitabine, paclitaxel, vinorelbine, or pemetrexed.
Targeted therapy
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.
Targeted drugs are prescribed based on the results of molecular diagnostics, which determines their potential effectiveness. Molecular diagnostics are carried out in specialized European laboratories and include 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 cases of systemic chemotherapy.
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Immunotherapy
If molecular diagnostics do not reveal genetic disorders, the oncologists consider 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. 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, 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 only fully available in large or specialized hospitals. Thus, minimally invasive interventions require the purchase of expensive equipment and training of medical personnel and, the drugs for immunotherapy and targeted treatment must be approved at the local level, and so on. Therefore, patients who require high-tech or innovative treatment, often look 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 medical tourism operator and 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 a favorable cost of medical services, without overpricing for foreigners (saving up to 50%);
- making an appointment for consultation or hospitalization on your desired date;
- independent control of all stages of the medical program;
- assistance with buying and forwarding medicines;
- communication with the clinic after the treatment’s completion and 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, and transfers.
Please, leave a request for treatment on the official Booking Health website, and a competent representative of the company will contact you within 24 hours.
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Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
Cancer Treatment Centers of America
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