Chemotherapy

Numerous agents and regimes

Neoadjuvant

Stage IIIA (N2)
If tumour responds the patients are resected. No residual tumour at surgery means prolonged survival Experimental still.

Adjuvant

No evidence for any benefit in operated patients.
Role in N2 disease
All oat cell cancers

Radiotherapy

External beam means external X-rays. Can be given as single or multiple beam, and variable  fraction number.

Brachytherapy means local i.e. intra bronchial
Interstitial Brachytherapy means directly into tumour
Intra cavity Brachytherapy means locally adjacent i.e. in bronchus

Primary treatment

Stage 1 and 2 
Patients who refuse or unfit for surgery
Failure rate of 30 % for stage 1, and 70% for stage 2
5 year survival 5 to 40%

Neoadjuvant 

T3 Pancoast tumours prior to surgery


Adjuvant for N1 / N2 disease

Reduces rate local recurrence
Survival unchanged
? Role in +Ve resection margins patients


Palliative

Symptomatic relief of  bone pain, haemoptysis, bronchial and SVC obstruction


Brachytherapy

Local application high local dose

Combined Chemotherapy and Radiotherapy

Neoadjuvant or Adjuvant

Can be sequential, concurrent, or alternating.

Good performance status needed.
Not standard practice

May increase risk surgery