While clinical trials continue to search for the best chemotherapy regimen, the most standard therapy today is combined systemic chemotherapy and chest radiation therapy with prophylactic cranial irradiation given to complete responders. The added benefits of the chest radiation therapy appear greatest if it is given concurrent with chemotherapy early in the patients treatment course. The morbidity of the concurrent approach should decrease as newer chemotherapy regimens not containing Adriamycin replace the older regimens.
Palliative Radiation Therapy
Radiation therapy is the single most effective agent available for the palliation of symptoms due to locally advanced or metastatic lung cancer. Bleeding, pain, and signs and symptoms due to mass effect (superior vena caval syndrome, atelectasis, headache, paresis, nausea, jaundice) can be palliated in the majority of patients with a brief course (10 to 15 fractions) of radiation.
Radiation may be combined with surgery in the management of brain and bone metastases. Patients with surgically accessible single brain metastases as the only site of metastatic disease who have a good performance status and whose primary disease is under control should be considered for neurosurgery prior to radiation therapy.