Lung Cancer.pdf

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Palliative Care in Patients with Lung Cancer 223 Table 12–2. Preoperative Symptoms Measured in the Thoracic Center Zubrod performance score Pain Anorexia Degree of pain Bone pain or symptoms Mild / moderate / severe Cough Pneumonia Diarrhea Pneumothorax Degree of diarrhea Gastroesophageal reflux Mild / moderate / severe Degree of reflux Dysphagia Mild / moderate / severe Degree of dysphagia Shortness of breath / dyspnea Mild / moderate / severe Degree of dyspnea Fatigue Mild / moderate / severe Fever Other Hemoptysis Symptom duration (of longest-lasting Hoarseness Horner’s syndrome Myasthenia Neurological symptoms symptom) Table 12–3. Postoperative Symptoms Measured in the Thoracic Center Zubrod performance score Incisional pain Bone pain or symptoms Degree of incisional pain Cough Mild / moderate / severe Diarrhea Neurological symptoms Degree of diarrhea Gastroesophageal reflux Mild / moderate / severe Degree of reflux Dysphagia Mild / moderate / severe Degree of dysphagia Shortness of breath / dyspnea Mild / moderate / severe Degree of dyspnea Fatigue Mild / moderate / severe Fever Hemoptysis Hoarseness Other Symptoms and Palliative Treatment Approaches Constitutional Symptoms The majority of patients with lung cancer develop fatigue, general malaise, anorexia, and weight loss during or after therapy. In many cases, these symptoms are not specific indicators of a particular systemic or organ-specific problem but rather constitutional symptoms due to a combination of the patient’s individual health, the tumor burden, sequelae of therapy, and the patient’s nutritional status. Modification of social habits (such as alcohol use) and addictions (such as tobacco addiction) and efforts to ensure proper hydration and nutri-
224 J.B. Putnam, Jr. tion—including calorie counts and use of nutritional supplements and vitamins—may ameliorate constitutional symptoms and improve the patient’s sense of well-being. In patients treated with chemotherapy or radiation therapy, special efforts should be made to attenuate treatment-specific side effects (see chapter 13) to enhance the patient’s sense of well-being. Symptoms Due to Brain Metastases The majority of patients with lung cancer have locally advanced disease or metastases at diagnosis. Brain metastases may present with seizures, and bone metastases may present with pain. Brain metastases—even metastases involving the dura—can be successfully resected, and resection of brain metastases can result in significantly improved quality of life (Rumana et al, 1998) and survival. Survival in patients with brain metastases as the only site of distant spread may be better than survival in patients with unresectable or more diffuse metastatic disease. In patients with lung cancer who have brain metastases at the time of diagnosis of their disease, the brain metastases are frequently resected before the primary lung tumor is treated. In this situation, recommended treatment for the primary tumor would be resection in patients with clinical stage I or II disease or concurrent chemotherapy and radiation therapy in patients with clinical stage III or IV disease (Bonnette et al, 2001). In patients with lung cancer who develop brain metastases after the completion of definitive therapy for their primary tumor, resection of the brain metastases is recommended whenever possible in physiologically fit individuals. Radiation therapy for brain metastases can also produce excellent results. Good symptom relief and improved function can be expected with this approach. Depression More insidious than physical symptoms of lung cancer, but perhaps more devastating for patients with lung cancer, is depression. Depression during end-of-life care may be variable and can be difficult to treat to the patient’s or family’s satisfaction. Pharmacologic and psychiatric therapy may be of great value in patients with depression and their families. Pain A complete discussion of the numerous options available for pain relief in patients with lung cancer is beyond the scope of this chapter. Good sources of detailed information on this topic include the National Comprehensive Cancer Network Practice Guidelines for Cancer Pain (Benedetti et al, 2000), which offer a detailed algorithm for treatment of cancer-related pain, and the Web site of M.D. Anderson’s Pain Research Group, which lists several excellent resources (Pain Research Group, 2002).
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Lung Cancer Frank V. Fossella, MD R
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Frank V. Fossella, MD Department of
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vi Foreword possible. Since the res
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x Contents Chapter 7 Surgical Treat
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xii Contributors Joe B. Putnam, Jr.
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2 J.B. Putnam, Jr., F.V. Fossella,
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26 F.V. Fossella common sites of lu
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28 F.V. Fossella history and physic
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30 F.V. Fossella Computed Tomograph
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32 F.V. Fossella Pulmonary Function
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34 F.V. Fossella The use of flexibl
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36 R.F. Munden and J.J. Erasmus hav
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38 R.F. Munden and J.J. Erasmus che
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40 R.F. Munden and J.J. Erasmus tha
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42 R.F. Munden and J.J. Erasmus (Gu
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44 R.F. Munden and J.J. Erasmus A B
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46 R.F. Munden and J.J. Erasmus in
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48 R.F. Munden and J.J. Erasmus Pat
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50 R.F. Munden and J.J. Erasmus D C
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52 R.F. Munden and J.J. Erasmus A B
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54 R.F. Munden and J.J. Erasmus Bol
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56 R.F. Munden and J.J. Erasmus Swe
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58 P. Tamboli and J.Y. Ro Chapter O
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60 P. Tamboli and J.Y. Ro Figure 4-
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62 P. Tamboli and J.Y. Ro Postopera
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64 P. Tamboli and J.Y. Ro Table 4-1
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66 P. Tamboli and J.Y. Ro Atypical
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68 P. Tamboli and J.Y. Ro Diffuse I
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70 P. Tamboli and J.Y. Ro noma. Cig
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72 P. Tamboli and J.Y. Ro Figure 4-
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74 P. Tamboli and J.Y. Ro alone. BA
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76 P. Tamboli and J.Y. Ro Other Mal
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78 P. Tamboli and J.Y. Ro Electron
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80 P. Tamboli and J.Y. Ro Niho S, Y
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82 Y. De Jesus and G.L. Walsh Chapt
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84 Y. De Jesus and G.L. Walsh Figur
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86 Y. De Jesus and G.L. Walsh guide
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88 Y. De Jesus and G.L. Walsh with
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Figure 5-2. Patient “pathway to r
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94 Y. De Jesus and G.L. Walsh Recov
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98 Y. De Jesus and G.L. Walsh KEY P
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100 Y. De Jesus and G.L. Walsh Jenn
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102 W.R. Smythe nation for these su
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104 W.R. Smythe patient reports of
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106 W.R. Smythe bar or limited lung
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108 W.R. Smythe hospitals for 149 p
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110 W.R. Smythe Figure 6-1. Postsur
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112 W.R. Smythe nant neoplasms has
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114 W.R. Smythe Future Directions F
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116 W.R. Smythe Henschke CI, McCaul
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7 SURGICAL TREATMENT OF LOCALLY ADV
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120 S.G. Swisher Treatment Options
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122 S.G. Swisher Initial Assessment
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124 S.G. Swisher Figure 7-1. Region
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126 S.G. Swisher Table 7-2. (contin
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128 S.G. Swisher upper paratracheal
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130 S.G. Swisher is performed only
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132 S.G. Swisher chance for long-te
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134 S.G. Swisher Pancoast tumors th
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136 S.G. Swisher A B Figure 7-2. Do
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138 S.G. Swisher a combination of t
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140 S.G. Swisher Dartevelle PG, Cha
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8 NONSURGICAL TREATMENT OF EARLY-ST
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144 R. Komaki morbid conditions pre
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146 R. Komaki and 26 patients had c
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148 R. Komaki Around 1998, by using
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150 R. Komaki Table 8-5. Survival a
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152 R. Komaki A total of 610 patien
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154 R. Komaki tially obstructed air
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156 R. Komaki report of Radiation T
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9 TREATMENT OF PATIENTS WITH ADVANC
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160 R. Zinner chemotherapy, in pati
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Table 9-1. Chemotherapy in Older Pa
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164 R. Zinner results of additional
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Table 9-3. Third-Generation-Agent M
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Table 9-4. Third-Generation Agents
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Table 9-5. Third-Generation Platinu
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Page 187 and 188: 174 R. Zinner may play an important
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Page 191 and 192: 178 R. Zinner wards higher survival
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Page 201 and 202: 188 R. Komaki Age is not a signific
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Page 207 and 208: 194 R. Komaki twice daily to a tota
Page 209 and 210: 196 R. Komaki Intergroup study 0096
Page 211 and 212: 198 R. Komaki Figure 10-1. Survival
Page 213 and 214: 200 R. Komaki cisplatin with concur
Page 215 and 216: 202 R. Komaki KEY PRACTICE POINTS
Page 217 and 218: 204 R. Komaki tients (Pts) with lim
Page 219 and 220: 206 R. Komaki Wagner H, Kim K, John
Page 221 and 222: 208 G.R. Blumenschein, Jr. recurs a
Page 223 and 224: 210 G.R. Blumenschein, Jr. syndrome
Page 225 and 226: 212 G.R. Blumenschein, Jr. toxicity
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Page 235: 222 J.B. Putnam, Jr. therapy. Patie
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Page 255 and 256: 242 A.A. Vaporciyan, J.F. Kelly, an
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Page 271 and 272: 258 E.S. Kim and F.R. Khuri A secon
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274 E.S. Kim and F.R. Khuri changes
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276 E.S. Kim and F.R. Khuri KEY PRA
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278 E.S. Kim and F.R. Khuri Hong WK
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15 MOLECULAR EVENTS IN LUNG CANCER
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282 W.N. Hittelman, J.M. Kurie, and
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300 Index Anterior spinal column re
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302 Index Cardiac murmurs, 104 Card
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304 Index Diagnosis. See also under
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306 Index Growth. See Tumor growth
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308 Index Magnetic resonance (MR) i
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310 Index p16 gene, 285 p19 arf gen
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312 Index Pulmonary resection (cont
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314 Index Squamous metaplasia, 263-
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316 Index Vitamin A, 262 Vocal cord
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