5. Nodal Anatomy Data from Autopsy Series Kunz et al 1985

6. Nodal Drainage

10. Clinical Features: Thoracic Disease Local Symptoms Cough Dyspnea Chest Pain Mediastinal Involvement Hoarseness Retrosternal Chest pain Vocal Cord Palsy Horner's Syndrome Superior Vena Caval Syndrome Hemoptysis Post obstructive Wheezing

20. Evolution of pathological classification

24. Chest X rays Pleural Effusion Phrenic Nerve palsy Mass Collapse

25. Radiology Miller WE: Roentgenographic manifestations of lung cancer. In Strauss MJ (ed): Lung Cancer: Clinical Diagnosis and Treatments, 2nd ed. New York, Grune and Stratton, 1983.

26. CT scan Mass Pleural Effusion Node Necrosis Mediastinal Shift

29. VALSG vs ISALC : LD

32. Management of SCLC

33. Treatment Outline SCLC Stage Localized Disease Extensive Disease Radiation Therapy (Curative intent ?) + Systemic Combination Chemotherapy Systemic Combination Chemotherapy + Palliative Radiation + Palliative Care and Support

34. Radiation Sensitivity Source: Radiation Biology of Lung Cancer; Sullivan et al JCB supp24

42. Portal arrangements Upper Lobe Middle Lobe Lower lobe

43. Critical organs and doses

45. Results

46. Effect of palliative RT

47. Changing Paradigms of R x Paradigm 1 : Surgery as Standard Treatment Paradigm 2 : Thoracic radiation better than Surgery Paradigm 3 : Thoracic Irradiation with adjuvant Chemotherapy Paradigm 4 : Combination chemotherapy with adjuvant Radiotherapy Paradigm 5 : Integrated Chemotherapy and Radiation therapy

48. RT results 2 yr survival 2 yr local control

53. Ideal Volume

56. Post CCT or Pre CCT volume? 21/5/1977 6/7/1977 26/8/1977 11/10/1977 26/10/1977

59. Time, Dose & Fractionation

62. Altered Fractionation Conclusion : Altered fractionation with split course is not effective

63. Continuous AF schemes Conclusion : Sadly Continuous AF is too toxic for routine use !!!

64. Sequencing with CCT

71. Timing of RT

73. Timing of RT Conclusion : Early Start of RT does lead to a better outcome

74. Role of PCI

81. Chemotherapy

83. Single Agent Chemotherapy

84. Standard CCT regimens

87. Alternative Chemotherapy

92. Dose intensification Conclusion : Dose intensification by 25 – 50% over the standard doses fails to improve the survival but increases toxicity significantly

93. Weekly Chemotherapy Conclusion : Dose intensification by giving weekly CCT fails to improve the survival but increases toxicity significantly

96. SVCO in SCLC

103. Response to RT

112. Thank You