When should I consider radiation for lung cancer?
When should I consider radiation for lung cancer?
After a diagnosis of lung cancer, many people are not sure about the role of radiation or indeed on what to expect from radiation therapy. This article summarizes several reasons why you may wish to consider radiation treatment.
Localized and regional disease
The first is for “curative” intent. Radiation treatment is typically offered to patients with localized or regional disease when surgery is not considered to be a good option (e.g. existing diseases one may have that predisposes to higher risk of complications) or simply as a result of your choice (due to a preference not to have an operation).
For patients with very early localized lung cancer (stage I), radiation is often delivered in a short course of 3-5 days with a technique called stereotactic ablative body radiation (SABR), in which a high dose of radiation is delivered each day. Two small studies suggest that overall survival was better in patients with localized lung cancer who received radiotherapy compared to surgery.[1] However as the two trials were stopped before they could be completed, the findings of better survival was considered to be inconclusive.
For stages II and III, it is not safe to deliver radiation at such high daily doses, and as a result it is spread out over several weeks. In this setting, radiation is often delivered at the same time as chemotherapy.
Distant disease
Radiation therapy can also be delivered in distant (stage IV) disease, where the cancer has spread outside the chest. There are a number of reasons why radiation may be given in this setting. The first is for troublesome symptoms such as pain or bleeding, the second is when the cancer has spread to a region that poses a risk if it continues to grow (such as in the brain or spinal cord) and the third is there is small amount of disease outside the chest where radiation is used to treat all of the cancer sites. A number of small studies have been conducted suggesting longer survival when all sites of disease are treated after initial chemotherapy, and many larger studies are now underway.
The author Dr Daniel Gomez has been supported by Varian (company that manufacturers radiotherapy equipment), AstraZeneca, Olympus, GRAIL, AstraZeneca and MedLearning Group.
References
1. Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, Groen HJ, McRae SE, Widder J, Feng L, van den Borne BE, Munsell MF, Hurkmans C, Berry DA, van Werkhoven E, Kresl JJ, Dingemans AM, Dawood O, Haasbeek CJ, Carpenter LS, De Jaeger K, Komaki R, Slotman BJ, Smit EF and Roth JA. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16:630-7.
2. Iyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, Dowell JE, Cheedella N, Nedzi L, Westover KD, Pulipparacharuvil S, Choy H and Timmerman RD. Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol. 2018;4:e173501.
3. Gomez DR, Tang C, Zhang J, Jr GRB, Hernandez M, Lee JJ, Ye R, Palma DA, Louie AV, Camidge DR, Doebele RC, Skoulidis F, Gaspar LE, Welsh JW, Gibbons DL, Karam JA, Kavanagh BD, Tsao AS, Sepesi B, Swisher SG and Heymach JV. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non–Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. J Clin Oncol 2019;37:1558-1565.