What we know about Lung Cancer is rapidly changing. Recently there have been new lung cancer screening guidelines, new methods of diagnosing lung cancer, and exciting changes in the treatments.  In my blog, I will try and make sense of the latest studies and news releases by placing them within a broader context.  I will also expose bias and inconsistency when present.

Lung Cancer in a Patient with COPD

Rizwan Nurani Lung Cancer Blog

Chronic Obstructive Pulmonary Disease (COPD) is common in patients with lung cancer.  COPD is characterized by a limitation in the patient’s ability to breathe air into and out of the lungs.  The condition is usually progressive, associated with an inflammatory (swelling) response and caused by cigarette smoking. Usually the patient has chronic bronchitis and emphysema superimposed on the airflow obstruction.

People who smoke and have COPD face a higher risk of developing lung cancer than smokers who do not have COPD.  Over half of all patients who develop lung cancer have a pre-existing diagnosis of COPD.  Previously, due to the fact that traditional external beam radiotherapy only controlled 30-50% of Lung cancers, surgery was the treatment of choice.  This was despite the fact that surgical resection of lung in patients who already had poor lung function carried a significant risk of debilitating breathing function in the future or even death in the days after surgery.  With the advent of radiosurgery and its demonstrated increased likelihood of tumor control, the question of how to best treat COPD patients was revisited.

Dr. Palma and Colleagues at VU University performed an analysis of 176 patients with moderate to severe COPD.  They then compared their results to similar patients treated with radiosurgery and traditional surgery at different institutions.  When they analyzed the multiple studies, they found that COPD patients treated with radiosurgery experienced 3 year local tumor control rates of 89% or higher depending on the study.  This compared to surgical local tumor control rates of 89% or higher.  However, the likelihood of the patients dying within 30 days of traditional surgery was higher with a range from 7% to 25%.  No patients died within 30 days of radiosurgery.  Thus,  1 year survival was 79-95% for radiosurgery and 45-86% for surgery.  Three year survival was 43-70% for radiosurgery and 31-66% for surgery.  The largest cause of death for both groups of treated patients was COPD as opposed to the controlled lung cancer.  The surgical group of patients spent an average of 8 to 12 days in the hospital.  Only 0%-3% of radiosurgery patients required any hospitalization at all.

radiosurgery vs surgery lung cancer rizwan nurani

This is an important study as it confirms that the high efficacy of radiosurgery and low likelihood of side effects remains true even in patients who were selected because they had particularly poor lung function.  The equivalent efficacy was expected.  The tolerance factor was difficult to fully predict and it is reassuring to see that the treatment was well tolerated in all three radiosurgery series examined.

© Rizwan Nurani 2012