Health Forums Online.

How a recurrence of disease is treated depends on how your first appearance of disease was treated, what type of lung cancer you have, what organs are affected, and how healthy you are overall. Because lung cancer treatments are evolving continually and because patients' medical circumstances differ, attempts to describe very specific treatments your doctor might recommend would be quickly outdated or incorrect for your circumstances. Several general points can be made, however.

Clinical trials
The National Cancer Institute recommends that all lung cancer survivors experiencing a recurrence of disease should consider clinical trials of new substances or techniques. If you didn't familiarize yourself with clinical trials during your first experience with lung cancer, now is a good time to do so. Clinical trials are a good way to gain access to newer, possibly more effective treatments before they are made available to the general public. Having some familiarity with what chemical agents, surgical techniques, and radiologic techniques are being tested will position you to make sound decisions about subsequent treatment. Chapter 20, Clinical Trials, Chapter 22, Researching Your Illness, and Chapter 23, The Future of Therapy, can help guide you through the process of choosing a clinical trial for recurrent disease.

Recurrent NSCLC
Recurrent NSCLC might be found in a single site, such as with several new lung tumors or a solitary brain tumor, or it may recur as widespread disease affecting several organs. A new lung tumor after a substantial disease-free period is evaluated and treated as if it were the first lung tumor.

Treatment options recommended by the NCl and our medical reviewers:
• Radiation therapy to relieve symptoms rather than cure disease
• Chemotherapy:
- Cisplatin, vinblastine, and mitomycin
- Cisplatin and vinorelbine
- Cisplatin and paclitaxel
- Cisplatin and gemcitabine
- Carboplatin and paclitaxel
- One medical reviewer notes that docetaxel is now used, as well
• Surgery or stereotactic radiosurgery to remove an isolated brain tumor, only if no other tumors remain in the lungs or elsewhere
• Surgery to remove a single tumor in a single metastatic site, such as the adrenal gland
• Laser therapy or interstitial radiation therapy for endobronchial lesions to ease breathing, not to cure disease

Recurrent SCLC
Recurrent SCLC might be found in a single site, such as a single brain tumor, but it most often recurs as a distant and widespread disease affecting several organs, including bones such as the ribs, spine, pelvis, or legs. A new lung tumor after a substantial disease-free period should be evaluated and treated as if it were the first lung tumor, and it should be rebiopsied for SCLC versus NSCLC.
Treatment options recommended by the NCI and our medical reviewers:
• Radiation therapy to relieve symptoms, not to cure.
• Second chemotherapy attempts, which might provide some relief from pain or uncomfortable symptoms for patients who were previously sensitive to earlier chemotherapy. NCI says, "While no Single chemotherapy regimen should be considered standard, those that have shown activity as second line treatment include:
- Oral etoposide
- Etoposide/cisplatin
_ Cyclophosphamide/doxorubicin/vincristine (CAV) - Lomustine/rnethotrexate
- Paclitaxel
- Topotecan"
• Endobronchial laser therapy, endobronchial stents, or brachytherapy to relieve symptoms of airway obstruction.
• Trials of new chemotherapy agents.

Drug resistance
If chemotherapy is planned and you have received chemotherapy previously, your oncologist might assume that the drugs you were given at first, at least at their initial doses, would not be the best choice for treating recurrence. The thinking is threefold:
• If these drugs were very effective, your disease would not have recurred.
• Certain lung cancers can become resistant to drugs.
• Some drugs are toxic to various organs; their lifetime dose must be limited.
This means that, for subsequent chemotherapies, it's usually the case that a second drug or series of drugs will be attempted.

The doctor may mostly recommend radiation therapy even if CT scan results do not show that the cancer has spread to the nodes.

There are 3 options:

Retroperitoneal lymph node dissection

Careful observation with frequent (usually monthly) doctor visits and tests for several years.


Immediate treatment with 2 cycles of chemotherapy.