DNA Microarray technology allowed analysis of gene expression profile of lung cancer (NSCLC and SCLC). Better understanding of the molecular and biological basis of this disease has led to the identification of a number of druggable targets. In the last years, targeted therapies with small molecule kinase inhibitors showed promising clinical activity in lung carcinoma but after some period of time...
Lung cancer is one of the most frequent causes of cancer deaths worldwide. Current treatment regimens with conventional anticancer therapies offer only a limited survival benefit. There clearly exists a need for the development of new therapeutic strategies. Recent evidence suggests that angiogenesis is critical to lung cancer progression and related to poor prognosis. Consequently tumor angiogenesis,...
Interventional pulmonology is relatively new field within pulmonary medicine focused on use of advanced bronchoscopy methods and interventional techniques in diagnosis and therapy of respiratory diseases. Various respiratory disorders may result in central airway obstruction (CAO), and central airway obstruction can cause significant morbidity and mortality. Exact data on incidence and prevalence...
Over the past decade, the diagnosis, treatment and management of lung cancer has evolved substantially, in large part to the development of novel chemotherapeutic agents and targeted therapy in particular. As such, accurate classification of lung carcinomas from a histologic standpoint has become increasingly critical for appropriate patient management. Much of the focus of lung cancer pathology in...
Recent advances in technology like faster, high resolution CT scanners, new data in lung cancer screening combined with many changes in the classification, staging and novel therapies for lung cancer are redefining the role imaging plays in detection, staging and management of the disease. This chapter describes the utility and limitations of the different radiological modalities in various stages...
Positron emission tomography (PET) is an imaging technique, which allows for accurate non-invasive measurements of metabolic pathways in tissues of man in vivo. The most frequently used tracer in PET oncology is the glucose analog 18F-fluoro-2-deoxy-glucose (FDG). The preferential accumulation of FDG in neoplastic cells permits differentiation between benign and malignant tissue. The ability to perform...
This chapter reviews surgical approaches to determining T, N, and M status for lung cancer; an expanded description of individual mediastinal staging modalities; the evidence for invasive mediastinal staging procedures and multi-modality staging strategies; and staging practices in the community at large.
Lung cancer is the most common cancer worldwide. Current estimates project over 222,000 new cases of lung cancer in the US alone in 2010, amounting to over 157,000 deaths. Despite a modest improvement in 5-year survival over the past three decades, deaths from lung cancer continue to exceed cancer deaths from all other sites. This chapter updates the role of surgical resection in the management of...
We reviewed recent investigations on radiation response of normal lung tissue and lung tumors and also introduced our own investigations. The mechanisms for response of normal lung tissues to radiation are not yet fully understood. Recent researches have revealed that various cytokines and lung parenchymal cells are involved in the pathogenesis of radiation response of normal lung tissues. Prediction...
Radiation therapy has been an important component of potentially curative treatment of lung cancer for more than 40 years. The radiosensitivity of normal tissues in the thorax, especially the normal lung and esophagus, has led to efforts to enhance the antitumor effects of radiation while reducing its acute and late adverse effects on normal tissues. Improving local control of medically inoperable...
Technological advances have become commercially available and widely implemented. In particular, 3D conformal therapy has become the first step in improving the targeting of dose to the tumor while sparing dose to normal tissue. The treatment planning process including beam design, treatment planning objectives, and dose calculation issues for 3D radiation treatment planning will be reviewed. Topics...
The purpose of this chapter is to review 4-dimensional radiotherapy (4DRT) for lung cancer in a way that supports the wider adoption of existing technologies and effective treatment strategies. 4DRT is defined, the components of a 4DRT program are identified, resource-sensitive 4DRT strategies are addressed and our own institution's approach to 4D lung RT is discussed.
Positron emission tomography (PET) is a major advance in lung cancer imaging and is having an increasing impact on the management of patients with non-small cell lung cancer who are candidates for potentially-curative treatment with radiotherapy. PET imaging, using 18F-flurodeoxyglucose as the tracer, and more recently in the form of FDG-PET/CT is now the most important single imaging modality for...
Proper target volume delineation is a crucial stage of treatment planning, so any error introduced in this process is a systematic error and cannot be quantified and/or detected by modern treatment technologies, unlike other sources of geometrical uncertainties. All steps of target definition should be standardized. In non-small cell lung cancer radiotherapy, there are specific problems related to...
What constitutes the appropriate target in the treatment of small-cell lung cancer is an area of active investigation. Advances in the last 30 years in radiologic and nuclear imaging as well as in radiotherapy delivery have prompted revision of the classically defined target which was designed to be “tolerable” and encompass visible tumor and potential areas of microscopic disease. Current trends...
Discovery of effective radiosensitization strategies that improve the therapeutic ratio for patients with lung cancer has been a goal of researchers and an area of vigorous investigation for the past several decades. A pure radiosensitizer is a drug, a modality of therapy or an intervention that, on its own, lacks direct anti-tumor activity but enhances the cytotoxicity of radiotherapy when employed...
Lung cancer is the leading cause of cancer death in most developed countries. The prognosis remains poor with an overall survival rate at 5 years of only about 15%. Between 70 and 85% of all cases are histologically classified as non-small cell lung carcinoma (NSCLC). Radiation therapy has traditionally been the treatment of choice for locally advanced disease and medically inoperable early stage...
Worldwide, approximately 1.6 million new cases of lung cancer are diagnosed each year. It continues to be the leading cause of cancer death. With the use of systemic therapy in addition to radiation and surgical resection, the outcome of all lung cancer patients continues to improve. There is an absolute improvement not only in overall survival (OS) but also in the quality of life of these patients,...
Starting point for full realization of clinical achievements of combined radiation therapy and chemotherapy in lung cancer is nothing but full understanding of general theoretical consideration as well as basic radiobiological premises of combined radiation and chemotherapy. Both are nowadays considered as mandatory ingredients in any consideration of combined radiation therapy and chemotherapy in...