Current Cancer Therapy Reviews - Volume 14, Issue 2, 2018

Introduction: Lung cancer is the most prevalent malignancy worldwide and accounts for more cancer-related deaths than any other disease site, despite advances in early detection and management. Radiation therapy is used in the management of all stages of non-small cell lung cancer, including adenocarcinoma in situ/minimally invasive adenocarcinoma, and small cell lung cancer. Conclusion: This article provides a brief current overview of literature pertaining to the role of radiation therapy in the management of lung cancer.

Introduction: Malignant chest tumors are common tumors in humans. Among them, lung cancer including Non-Small-Cell Lung Cancer (NSCLC) and smallcell lung cancer are the most common types. Surgery alone for early-stage, or in combination with chemotherapy and radiation therapy for more advanced disease have been the major components of treatment strategies for the past few decades. The recent discovery of oncogenic drivers for NSCLC has led to the devise of new targeted therapies which dramatically improve the quality of life and survival of patients whose tumors harbor such mutations. New generations of targeted therapy which specifically target the drug-resistant mutations gradually evolve, benefiting patients who are refractory or intolerant to first-line targeted therapy. The survival of NSCLC patients without identifiable mutations has also improved, as contributed by use of the relatively non-toxic chemotherapeutic and anti-angiogenic agents, as well as the advances of radiation techniques with better tumor coverage and reduced toxicities. The treatment outcomes of other rarer chest tumors including mesothelioma, thymic epithelial tumors and neuroendocrine tumors have also improved significantly, secondary to earlier detection, more accurate and uniform diagnostic criteria and classification, emergence of new treatment options and multidisciplinary management. In addition, the epidemiology, patterns of genetic and environmental predisposition and treatment strategies of these tumors may differ substantially between Western and Asian countries. Conclusion: The approaches of this review are to highlight the recent management advances and contrast the differences of treatment practice between Western and Asian countries.

Introduction: Brachytherapy is a treatment in which sealed radioactive sources are used to deliver high doses of radiation at close distance to the tumor with rapid dose fall-off in the surrounding normal tissue resulting in high therapeutic ratio in oncological disease management. It is effective in palliative treatment for patients with symptoms of hemoptysis and dysnea resulting from endobronchial obstruction. Conclusion: In spite of the rapid development of external beam radiation therapy brachytherapy continues to remain an important mode of therapy and is often a default treatment when external beam radiation option is limited.

Palliation may be the goal of care for some patients with intra-thoracic lung cancer. Factors such as the extent of disease, comorbidities, performance status, or symptom burden, may indicate that patients are unsuitable for more aggressive approaches with a curative intent. A palliative treatment plan implies a focus on the effective relief and control of symptoms, while preserving both the quality and quantity of life. Therapeutic measures may include palliative radiotherapy, palliative chemotherapy, or other forms of systemic treatment. In addition, certain interventional procedures may be used to achieve symptom palliation, and to maintain or improve quality of life. While eliciting relatively mild toxicity risks, palliative radiation can offer significant therapeutic value to patients with chest tumors. External beam radiation therapy is the most common technique in these circumstances. Select patients with endobronchial disease may benefit from methods that directly place radioactive sources at tumors that are accessible through the airway. A number of common radiation protocols describe various dose-fractionation patterns. While the efficacy profiles of different radiation schedules have been shown to be comparable, the side effects with each regimen, as well as the potential duration of benefit, often differ. Studies to date show that there is no clear advantage to combining chemotherapy concurrently with radiation for the palliative treatment of chest tumors. Overall, the coordination and quality of care regarding selected treatment modalities, in continuity with efforts to support patient-defined goals, are of prime importance.

In Asia, North America and Europe, lung cancer remains one of the top contributors to cancer-related death. Oncology training programs span 4-5 years and palliative care fellowship is around 2 years. However, the multi-disciplinary conference is increasingly viewed as preferable to assist with decision making in most modern centers. Palliative care for lung cancer likewise differs between regions.

Introduction: End of life care can be given in a home setting, dedicated palliative care ward in a hospital or hospice. Nowadays, increasing number of patients request to have euthanasia or Medical Assistance in Dying (MAID) in the world. Such care can be provided legally in Canada since 2016. Conclusion: Different Canadian hospitals developed practical guidelines and procedures by 2017 already. Ramifications of MAID will be discussed in this review.