Standard Treatment Metastatic disease cannot be cured by any local therapy, 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 progressive tumor develop.
Chemotherapy with, for example, a platinum compound combined with drugs such as vinblastine , vindesine , etoposide or mitomycin-C can achieve response rates of about 30 percent in Stage IV cases. Although there has been only a very modest survival improvement with these agents, they may give palliative benefit by reducing the size of the tumors and relieving symptoms. Combinations currently in use include: cisplatin + etoposide, carboplatin + etoposide, cisplatin + mitomycin-C + vinblastine and cisplatin + etoposide + ifosfamide .
