Standard Treatment Metastatic disease cannot be cured by surgery, so treatment for this stage is directed toward relieving symptoms with either radiation therapy or chemotherapy .
Radiation may relieve local symptoms such as tracheal, esophageal or bronchial compression, bone or brain metastases, pain, vocal cord paralysis, coughing blood (hemoptysis) or superior vena cava syndrome. Patients without symptoms should be kept under close observation. Sometimes treatment may appropriately be deferred until symptoms or signs of a progressive tumor develop.
Chemotherapy with, for example, a platinum compound combined with drugs such as vinblastine , vindesine, etoposide or mitomycin-C has response rates of about 30 percent in Stage IV cases. Although there has been no evidence of major survival improvement with these agents, they may give palliative benefit by reducing the size of the tumors and relieving symptoms.
Recent trials using a cisplatin-based regimen of chemotherapy showed some survival benefit and give hope for more benefit in the future. Combinations currently in use include: cisplatin + etoposide, carboplatin + etoposide, cisplatin + mitomycin-C + vinblastine and cisplatin + etoposide + ifosfamide .
