Treatment for Stage IIIB Non-Small Cell Lung Cancer (NSCLC)
Question
My wife has just been confirmed through a biopsy of having stage IIIB non-small cell lung cancer. Lymph nodes in her neck and chest are involved. We have yet to see an oncologist. Hope to this week. What treatments are recommended? What other questions should we ask?
The pulmonologist stated that he thought treatment would be radiation therapy and chemotherapy. Is there anything else that can help, such as massive doses of vitamin D (I think I read that somewhere)?
Can this only be slowed down or can we contain and cure it?
Answer
Barbara Campling, MD, Medical Oncologist, responds:
Your wife has a non-small cell lung cancer, which originated in the lung and has spread to lymph nodes within the chest and to a lymph node in the neck. The fact that a lymph node in the neck is involved with cancer, without any evidence of spread to other parts of the body outside the chest, makes this a Stage IIIB. This stage of cancer cannot be removed surgically, but is still treatable with radiation therapy. In some cases of Stage IIIB non-small cell lung cancer, there is a small but very real possibility of eradicating the cancer with radiation therapy, and there is definitively hope of cure! Chemotherapy, especially when given concurrently with radiation therapy, can increase the chance of the radiation controlling the cancer within the chest and improve the likelihood of long-term survival. As for what to ask about, I recommend you read about lung cancer and make a list of questions for your oncology team. OncoPilot is a section that you may find helpful. It is designed to help newly diagnosed patients navigate their treatment and has some suggested questions to ask.
Your question about "massive doses of vitamin D" is very interesting. Laboratory studies have shown that Vitamin D can have anticancer effects. Vitamin D in the body comes from three sources: sun exposure, diet, and supplemental intake. There have been a number of recent epidemiological studies, which have shown that subjects with higher levels of vitamin D may have a decreased risk of developing, and a reduced mortality from, a variety of cancers, including lung cancer. It is not yet known whether supplemental vitamin D may improve the outcome for patients who have already been diagnosed with cancer. The recommended daily dose of Vitamin D is 400 International Units per day, and the "tolerable upper level" of intake is 2000 International Units/day. Your wife could be well advised to take Vitamin D in recommended doses, but she should be aware that excessive doses could be toxic and even fatal.
- Giovannnuci, E. et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. Journal of the National Cancer Institute, 98: p451 (2006)
- Zhou, W. et al. Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small-cell lung cancer patients. Journal of Clinical Oncology, 25: p479 (2007)
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