It is estimated that in 2004, roughly 174,000 Americans were diagnosed with lung cancer, and 164,000 of them will die of the disease (Spira and Ettinger, 2004). The five-year survival rate for lung cancer patients is only 14 percent, and yet lung cancer is curable in the early stages. Radiotherapy for lung cancer is performed using an external beam linear accelerator, with a dose of 60 Gy divided among 30 sessions given over six weeks. This radiation can have toxic effects on normal tissues such as pneumonitis, skin desquamation, and cardiac abnormalities. Concurrent chemotherapy can increase the effectiveness of the radiotherapy, but can also increase the adverse effects.
There are a variety of chemotherapeutic agents which are effective against small cell and non-small cell lung cancers, and the most effective is cisplatin, which cross-links DNA, and carboplatin, which is an analogue of cisplatin (Spira and Ettinger, 2004). Surgery is the major form of treatment for patients with non-small-cell lung cancer, and includes resection and mediastinal node mapping. If the nodes are involved, they need to be removed completely. Adjuvant therapy is the name for the combination of surgery followed by either radiation or chemotherapy.
Adjuvant radiotherapy is directed at at killing cancer cells remaining near the site where the tumor was removed, but results have been very variable to date, and the same is true for chemotherapy (Spira and Ettinger, 2004). A meta-analysis of all trials that took place from 1965 to 1991 showed that cisplatin treatment moderately reduced the risk of death, but not significantly. A combination of radiation and chemotherapy produced similar results.
Small cell lung cancers metastasize early in their course, so surgery is not usually an option (Spira and Ettinger, 2004). Solitary nodules with no metastases can be removed, followed by chemotherapy, usually of etoposide and cisplatin with vinc...