Common Surgical Methods

• Open Chest Surgery
  Currently, open chest surgery minimizes the separation of intercostal muscles and ribs. Using advanced operating equipment, surgeons can access the thoracic cavity to directly observe and excise the affected lung tissue.

• Video-Assisted Thoracoscopic Surgery (VATS)
  This technique employs miniature cameras and specialized surgical instruments through small incisions to observe the internal chest structures and treat tumors. VATS has shorter incisions, less trauma, faster recovery, and good outcomes, making it a primary surgical method for lung cancer in China.

• Robot-Assisted Thoracoscopic Surgery (RATS)
  Also known as the Da Vinci robotic-assisted thoracoscopic surgery, RATS offers enhanced three-dimensional vision and highly precise, dexterous robotic arm operations. It has gained popularity among surgeons due to its safety, effectiveness, and lower rates of intraoperative conversion and postoperative complications, effectively addressing the limitations of traditional thoracoscopy.

Radiation Therapy

Radiation therapy is a significant treatment option for lung cancer and can enhance the efficacy of chemotherapy. It is particularly effective for small cell lung cancer. Radiation is suitable for patients with localized advanced disease or those unable to undergo surgery due to age or compromised heart and lung function. It is not recommended for patients with severe heart, lung, liver, or kidney dysfunction.

Radiation therapy can be categorized into several types:

• Curative Radiation Therapy: Used for smaller lesions without metastasis in patients who cannot undergo surgery for anatomical or other reasons.
• Palliative Radiation Therapy: Suitable for patients with persistent cough, hemoptysis, lung collapse, superior vena cava syndrome, bone metastatic pain, or brain metastasis symptoms.
• Adjuvant Radiation Therapy: Used for preoperative treatment, or for patients with positive surgical margins or multiple mediastinal lymph node metastases post-surgery.
• Prophylactic Radiation Therapy: Administered to patients with effective systemic treatment for small cell lung cancer, such as whole-brain radiation therapy.

Chemotherapy

Chemotherapy involves the use of oral or injectable chemical agents to kill cancer cells, making it a primary method for treating lung cancer, with over 90% of lung cancer patients requiring it.

• Chemotherapy for Small Cell Lung Cancer:
  Chemotherapy is effective for both early and late stages, with about 1% of early-stage patients achieving a cure. First-line chemotherapy drugs include etoposide and irinotecan combined with cisplatin or carboplatin, typically administered over 4 to 6 cycles.

• Chemotherapy for Non-Small Cell Lung Cancer:
  Chemotherapy generally does not cure but alleviates symptoms and improves quality of life. First-line chemotherapy typically includes platinum-based regimens, administered over 4 to 6 cycles. For adenocarcinoma, preferred regimens include pemetrexed with platinum (AP or AC regimens), while squamous cell carcinoma may use gemcitabine with platinum (GP or GC regimens) or docetaxel with nedaplatin.

Chemotherapy is not recommended for elderly, frail patients, those with severe organ dysfunction, poor bone marrow function, or those with complications and bleeding tendencies.

Interventional Therapy

Interventional therapy involves using imaging guidance to direct therapeutic instruments like needles, catheters, and guidewires to the site of the lesion. Techniques include:

• Tracheal Arterial Chemotherapy: Suitable for late-stage patients who cannot undergo surgery and have failed systemic chemotherapy.
• Bronchoscopic Interventional Therapy: Used for patients who cannot undergo surgery or radiation therapy.

Drug Therapy – Targeted Therapy

Targeted therapy involves drugs developed to act specifically on known cancer-driving genes, inducing tumor cell death while sparing normal tissues. This approach can significantly extend patient survival, mainly used in adenocarcinoma of non-small cell lung cancer.

Before targeted therapy, genetic testing of tissue or blood is crucial to identify the presence of driver genes and their mutation types, which guides drug selection. Common drugs include:

• EGFR Tyrosine Kinase Inhibitors like gefitinib for EGFR mutation-positive patients.
• ALK and ROS1 Inhibitors like crizotinib for patients with ALK or ROS1 rearrangements.
• Anti-angiogenic Agents like bevacizumab targeting tumor blood vessels.