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6. Management
6.1 Non-Small Cell Lung Cancer (NSCLC)
01) Resectable NSCLC
02) Surgical Treatment of Stage I-IIIA
03) Adjuvant Radical Radiotherapy Following Surgical Resection
04) Post-operative Adjuvant Chemotherapy for Resected NSCLC
05) Radical Radiotherapy for Potentially Resectable but Inoperable T1, T2, N0, M0
06) Combined Modality Therapy for Unresectable Stage III
07) Combined Modality Therapy for Potentially Resectable Stage III
08) Patient Selection for Combined Modality Therapy
09) Chemotherapy in Combined Modality Regimens
10) Thoracic Radiotherapy In Combined Modality Therapy
11) Thoracic Radiotherapy Alone in Stage III
12) Advanced NSCLC Treated with Palliative Intent
13) Palliative Radiotherapy for Locally Advanced and Metastatic NSCLC
14) Palliative Chemotherapy of Advanced NSCLC
15) Palliative Second-line Chemotherapy for Advanced NSCLC
16) Endobronchial Therapy
Pre-operative Radical Radiotherapy

12) Advanced NSCLC Treated with Palliative Intent

Updated February 2008

About 30% of NSCLC patients have stage IV disease and a large proportion of patients with stage III NSCLC are not treatable with curative intent. Patients with a malignant pleural effusion are not curable and are most appropriately treated similarly to those with stage IV disease. Important prognostic factors include: stage, performance status and weight loss.

Treatment goals in these patients should always include palliation of symptoms and improvement in quality-of-life, but may include an attempt to prolong survival in patient groups suitable for chemotherapy. Treatment options include supportive care, palliative radiotherapy or chemotherapy. Toxicity of concurrent chemoradiation as applied in the curative setting is not justified in the palliative setting.

The prognosis for patients with stage IIIB and IV NSCLC is grave with 6-10 month median survival times being typical even with the best available therapies. Most patients die within 1 or 2 years.