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Thoracic oncology ?

Thoracic oncology focuses on the diagnosis and treatment of cancers occurring in the chest (thorax), including:

Lung Cancer: Most common cancer among women worldwide.

  • Non-Small Cell Lung Cancer (NSCLC): The most common type, accounting for ~85% of lung cancers. Includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

  • Small Cell Lung Cancer (SCLC): More aggressive, tends to metastasize early.

Esophageal Cancer: Most common cancer among women worldwide.

  • Commonly classified into squamous cell carcinoma and adenocarcinoma.

  • Requires a multimodal treatment approach involving surgery, chemotherapy, and radiotherapy.

Mesothelioma:Rare cancer of the pleura, often associated with asbestos exposure.

Thymoma and Thymic Carcinomas:Rare tumors of the thymus gland, often treated with surgery and adjuvant therapies.

Metastatic Lesions in the Thorax:Tumors from other primary sites (e.g., breast, colorectal, kidney) that metastasize to the lungs or pleura.

Radiation Oncology in Thoracic Cancers

Radiotherapy plays a critical role in thoracic oncology, both for curative and palliative purposes. Advanced techniques include:

External Beam Radiotherapy (EBRT)

  • IMRT and VMAT to reduce dose to nearby critical organs like the heart, esophagus, and spinal cord.

  • Stereotactic Body Radiotherapy (SBRT) for early-stage lung cancer or oligometastases.

BrachytherapyHigh-dose-rate (HDR) endobronchial brachytherapy for obstructive lesions or recurrent disease in the airway.

Proton TherapyGaining popularity for minimizing dose to critical organs, especially in pediatric and complex cases.

Combined Modality TherapyChemoradiation is often the standard for inoperable or locally advanced cancers like NSCLC and esophageal cancer.

Treatment modalities in thoracic oncology involve a multidisciplinary approach to manage cancers of the lung, esophagus, mediastinum, and pleura. These modalities include surgery, radiotherapy, systemic therapies, and supportive care, tailored to the cancer type, stage, and patient factors.

Surgery

Surgery is the cornerstone for early-stage thoracic cancers, offering the best chance for cure.

  • Lung Cancer

  • LobectomyStandard of care for NSCLC.

  • PneumonectomyFor centrally located tumors.

  • Segmentectomy/Wedge Resection: For early-stage disease or poor surgical candidates.

  • VATS (Video-Assisted Thoracic Surgery) or Robotic Surgery: Minimally invasive techniques.

  • Erlotinib and Gefitinib: Tyrosine kinase inhibitors used in some glioma and glioblastoma cases.

  • Esophageal Cancer

  • Esophagectomy with lymph node dissection

  • Minimally invasive esophagectomy in selected cases.

  • Thymomas and Mesothelioma

  • Complete resection with or without adjuvant therapy.

Radiation Therapy

Essential in both curative and palliative settings, especially for inoperable or advanced disease.

  • External Beam Radiotherapy (EBRT)

  • Intensity-Modulated Radiotherapy (IMRT): Precise targeting to spare nearby organs like the heart and spinal cord.

  • Stereotactic Body Radiotherapy (SBRT): Used for early-stage NSCLC, especially for non-surgical candidates.

  • Proton Therapy: Reduces dose to critical structures, especially for centrally located tumors.

  • Brachytherapy

  • High-dose-rate (HDR) endobronchial brachytherapy for recurrent or obstructive airway lesions.

  • Concurrent Chemoradiation

  • Standard for locally advanced NSCLC, esophageal cancer, and certain thymic cancers.

Systemic Therapy

Systemic treatments are critical for advanced, metastatic, or unresectable thoracic cancers.

Chemotherapy:

  • Platinum-based doublets (e.g., cisplatin/paclitaxel or carboplatin/pemetrexed) are the backbone for NSCLC and esophageal cancer.

  • Etoposide plus platinum agents for SCLC.

Targeted Therapy:

  • EGFR inhibitors (e.g., osimertinib) for EGFR-mutant NSCLC.

  • ALK inhibitors (e.g., alectinib) for ALK-positive NSCLC.

  • ROS1, BRAF, and MET-targeted therapies.

Immunotherapy:

  • PD-1/PD-L1 inhibitors (e.g., nivolumab, pembrolizumab) and CTLA-4 inhibitors in NSCLC and SCLC.

Combination Therapy:

  • Immunotherapy plus chemotherapy in advanced stages.

Multimodality Therapy

Combined approaches are standard for certain cancers:

Chemoradiation:

  • Concurrent chemoradiotherapy for locally advanced NSCLC and esophageal cancers.

Neoadjuvant Therapy:

  • Chemotherapy, immunotherapy, or chemoradiation to shrink tumors before surgery.

Adjuvant Therapy:

  • Post-surgical chemotherapy or radiation to eradicate microscopic disease.

Systemic Therapy

Systemic treatments are critical for advanced, metastatic, or unresectable thoracic cancers.

Chemotherapy:

  • Platinum-based doublets (e.g., cisplatin/paclitaxel or carboplatin/pemetrexed) are the backbone for NSCLC and esophageal cancer.

  • Etoposide plus platinum agents for SCLC.

Targeted Therapy:

  • EGFR inhibitors (e.g., osimertinib) for EGFR-mutant NSCLC.

  • ALK inhibitors (e.g., alectinib) for ALK-positive NSCLC.

  • ROS1, BRAF, and MET-targeted therapies.

Immunotherapy:

  • PD-1/PD-L1 inhibitors (e.g., nivolumab, pembrolizumab) and CTLA-4 inhibitors in NSCLC and SCLC.

Combination Therapy:

  • Immunotherapy plus chemotherapy in advanced stages.

Multimodality Therapy

Combined approaches are standard for certain cancers:

Chemoradiation:

  • Concurrent chemoradiotherapy for locally advanced NSCLC and esophageal cancers.

Neoadjuvant Therapy:

  • Chemotherapy, immunotherapy, or chemoradiation to shrink tumors before surgery.

Adjuvant Therapy:

  • Post-surgical chemotherapy or radiation to eradicate microscopic disease.

Supportive and Palliative Care

Essential for symptom relief, improving quality of life, and managing advanced disease:

Chemoradiation:

  • Palliative Radiotherapy

  • For pain, hemoptysis, or airway obstruction.

  • Palliative Chemotherapy/Immunotherapy.

  • To control disease progression.

  • Endoscopic Interventions

  • Stent placement for esophageal or airway obstruction.

  • Symptom Management

  • Pain management, management of pleural effusion, and dyspnea relief.

Thoracic oncology treatment decisions depend on tumor histology, stage, molecular profile, and patient comorbidities, making a personalized approach essential.

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