Assalamualaikum WR WB

Assalamualaikum wr wb
Thankyou moderator, today I will present my jurnal reading with the title
Multimodality Treatment of Advanced Non-small Cell Lung Cancer: Where are we with the
Evidence?
Slide 2:
Lung cancer
Lung cancer is the most common malignancy worldwide with over 1.8 million new cases diagnosed
each year.
Overall survival is poor and only around 15% of patients are alive 5 years after their initial diagnosis
Approximately 85% of lung cancers are non-small cell lung cancer (NSCLC)
Slide 3
A classification that amongst others encompasses small cell ca 15%, NSCLC 85% and devided to
Squamous 30% and non squamous 70%. Adenocarsinoma 90% and large cell ca 10%
Slidee 4
This is the histology of lung cancer
Small cell ca and non small cell ca
Slice 5
This is types of NSCLC:
Adenocarsinoma  most common form, usually begins in the outer regions of the lung
Squamous cell ca  Tend to cause early symptom, usually begins in th bronchial tube
Large Cell ca  tends to grow rappidly and cause late symptom, usually begins in the outer edges of
the lung
Slide 6
For patients with NSCLC, treatment options vary significantly by disease extent but have
considerably evolved across all disease stages
This article outlines the current and emerging impacts of these advances on the multimodality
treatment of advanced NSCLC within the specific settings of locally advanced and oligometastatic
disease
Slide 7
Types of treatmens of lung cancer
Lokal treatmens  Surgery and Radioterapi
Systemic treatment  Chemoterapy, Targeted terapi, Imunoterapi
Slide 8
Slide 9
Staging of NSCLC is assessed using the 8th version of the TNM staging system
For the small proportion of patients who present with early (stages I and II) NSCLC, resection remains
the gold-standard treatment.
in stage 2 can be given adjuvant chemotherapy after surgery
Slide 10
Overall survival following surgery is encouraging; 52–89% of patients with stage I disease and
between 33 and 52% with stage II cancer survive 5 years
Adjuvant chemotherapy may be of benefit in a subset of patients with stage IB tumours exceeding 4
cm in size.
Patients with early stages who cannot undergo surgery  can be given SBRT (stereotactic body
radiotherapy)
Slide 11
Patients with stage 2  surgery, can be given adjuvant chemotherapy
Adjuvant chemotherapy, broadly defined as chemotherapy given after surgery to reduce the risk of
recurrence, is recommended for completely resected stages II and III disease.
Adjuvant chemotherapy in NSCLC is in an attempt to reduce the rate of distant metastatic spread,
such as to the brain, liver, and adrenal glands.
Slide 12
Resectable disease typically includes T4N0 tumours for which complete (R0) resection is considered
by a multi-disciplinary team (MDT) to be feasible.
Resectable IIIA/N2 Disease
Adjuvant chemotherapy, broadly defined as chemotherapy administered after surgery in order to

reduce the risk of recurrence, is recommended in completely resected stage II and III disease
Slide 13
in contrast to resectable disease, the management of unresectable stage III NSCLC with definitive
chemoradiotherapy is now well standardised
Slide 14
Sistemyc terapi consist of chemoterapi, targeted terapi, imunocek point inhibitor
Slide 15
Oligometatatik disease, a subgroup of stage IV disease
Slide 16
A type of metastasis in which cancer cells from the primary tumor spread throughout the body and
form a small number of new tumors (metastatic tumors) in one or two other parts of the body.
Slide 17
Oligometastatic disease is increasingly recognised in a subset of patients with stage IV NSCLC
An important distinction in oligometastatic disease is whether metastatic lesions are identified at

disease diagnosis or following an initial disease-free period, respectively, termed synchronous and
metachronous disease
Slide 18
Synchronous cancers were defined as those occurring within 6 months of the first primary cancer,
while metachronous cancers were defined as those occurring more than 6 months later (12). Overall
survival was defined as the time from first primary cancer diagnosis to death (of any cause).
Slide 19
Treatments for NSCLC stage 4
Chemotherapy is the mainstay of choice for metastatic NSCLC
Platinum-based palliative cytotoxic chemotherapy forms the mainstay of treatment for 30-50% of
patients with NSCLC who present with metastases.
Slide 20
Specific Treatment Modalities
Slide 21
Surgery
● The surgical approach to oligometastatic disease varies according to the extent and location
of the metastases
● The type of surgery depends on the size and location of the tumor:
1. Segment resection is the removal of a small portion of the lung; may be performed in very early
stages of cancer
2. Lobectomy is the removal of a lobe of the lung; is the standard surgical treatment for NSCLC
3. Pneumonectomy is the removal of one lung; is a more complex surgical resection procedure than
a lobectomy or wedge (segment) resection.
Slide 22
- Radiotherapy  therapy using measured doses of radiation to destroy cancer cells and
prevent their growth
- Radiotherapy (stereotactic ablative radiotherapy [SABR] or conventional radiotherapy) 

an alternative to surgery for patients who are unable or unwilling to undergo surgery
- Stereotactic ablative radiotherapy (SABR)  A type of radiation therapy using an external

beam that delivers high doses of radiation, specific to the tumor
Slide 23
The management of oligometastatic disease involves the use of thermal ablative therapies such as
radiofrequency ablation—RFA (also known as image-guided thermal ablation (IGTA), cryoablation
and microwave ablation (MWA).
RFA is the technique and function most extensively evaluated by inducing coagulation necrosis of
the lung parenchyma.
RFA in medically inoperable patients, often in early NSCLC.
Slide 24
Treatment of oligometastatic disease will involve surgery, RT, and focal interventional-radiology-
guided ablative techniques in a manner that depends on the patient's comorbidities and the location
of the metastases.
studies to date have combined this intervention with chemotherapy and targeted inhibition of EGFR
and ALK, which to date have become the standard of care for stage IV NSCLC.
Immunotherapy is a growing area in lung cancer and is likely to make a significant impact in stage IV
disease.
Slide 25
Conclusion
● The evoluti on of radiotherapy technology, surgical techniques and the large number of
interventional radiology-guided ablative therapies are expanding the choice of treatment
modalities available to patients with NSCLC.
● In the treatment of locally advanced resectable disease and oligometastatic states, there is a
growing need for randomized comparisons of available treatment modalities to guide
treatment and patient selection.

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Assalamualaikum wr wb

This is the histology of lung cancer

Small cell ca and non small cell ca

This is types of NSCLC:

Types of treatmens of lung cancer

Lokal treatmens  Surgery and Radioterapi

Systemic treatment  Chemoterapy, Targeted terapi, Imunoterapi

in stage 2 can be given adjuvant chemotherapy after surgery

Patients with stage 2  surgery, can be given adjuvant chemotherapy

Resectable IIIA/N2 Disease

Adjuvant chemotherapy, broadly defined as chemotherapy administered after surgery in order to

Sistemyc terapi consist of chemoterapi, targeted terapi, imunocek point inhibitor

Oligometatatik disease, a subgroup of stage IV disease

Oligometastatic disease is increasingly recognised in a subset of patients with stage IV NSCLC

An important distinction in oligometastatic disease is whether metastatic lesions are identified at

Treatments for NSCLC stage 4

Chemotherapy is the mainstay of choice for metastatic NSCLC

Specific Treatment Modalities

- Radiotherapy (stereotactic ablative radiotherapy [SABR] or conventional radiotherapy) 

- Stereotactic ablative radiotherapy (SABR)  A type of radiation therapy using an external

RFA in medically inoperable patients, often in early NSCLC.

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