How is Radiation Therapy Used to Help

Lung Cancer Patients?Ray Mak, M.D.

Department of Radiation Oncology

Overview1. Role of Radiation Therapy in Non-Small Cell Lung

Cancer2. Role of Radiation Therapy in Small Cell Lung Cancer3. Conventional Radiation Therapy 4. Stereotactic Body Radiation Therapy 5. Palliative Conventional Radiation Therapy6. Summary

Radiation Therapy Approaches for Lung Cancer

Conventional Radiation Therapy

Stereotactic Body Radiation Therapy

For Cure

For Palliation

For Cure

of RT Treatment

of RT Treatment

of RT Treatment

Role of Radiation Therapy for Non-Small Cell Lung Cancer

Category Stage Role of Radiation Therapy

Localized I Stereotactic Body Radiation Therapy

Locally Advanced

III Conventional Radiation Therapy

Metastatic IV Palliative Radiation Therapy

Role of Radiation Therapy for Small Cell Lung Cancer

Category Stage Role of Radiation Therapy

Localized Limited Conventional Radiation Therapy

Metastatic Extensive Palliative Radiation Therapy

Conventional Radiation TherapyCurative Treatments

Category Stage Role of Radiation TherapyLocalized

Non-Small Cell

III Conventional Radiation Therapy

Localized Small Cell

Limited Conventional Radiation Therapy

• Small dose per day• More treatments longer course• Higher total dose of radiation to eradicate tumor• Can mean more side effects

of RT Treatment

Pre-operative Radiation Therapy

+

Chemotherapy

5-6 Weeks Daily Radiation Therapy

For Patients with Locally Advanced (Stage IIIA)Non-Small Cell Lung Cancer

Surgery

Review byPathologist

?More treatment

Post-operative Radiation TherapyFor Patients with Locally Advanced (Stage IIIA)

Non-Small Cell Lung Cancer

Surgery

Review byPathologist

High Risk Features +

Chemotherapy

5-6 Weeks of Daily Radiation Therapy

Curative Radiation Therapy

+

6-7 Weeks of Daily Radiation Therapy

Chemotherapy Monitoring of ResponseWith Scans Over Months

For Patients with Inoperable Locally Advanced Non-Small Cell Lung Cancer or Limited Stage Small Cell Lung Cancer

Role of Radiation Therapy Stereotactic Body Radiation Therapy

Category Stage Role of Radiation Therapy

LocalizedNon-Small Cell

I Stereotactic Body Radiation Therapy

Locally Advanced

III Curative, Conventional Radiation Therapy

(Preoperative, Postoperative, or Without Surgery)

Metastatic IV Palliative Radiation Therapy

Stereotactic Body Radiation Therapy• For patients with Stage I Non-Small Cell Lung

Cancer who cannot undergo surgery• A new technique developed in the last 10 years• High dose, pinpoint radiation to the lung tumor• 3 to 5 treatments over 1 to 2 weeks

Stereotactic Body Radiation Therapy• Requires high tech planning and imaging• Very high tumor control rates (~90%)

Live View of Moving TumorThrough the Radiation Portal

Courtesy Ross Berbeco

Role of Radiation Therapy Palliative Radiation Therapy

Category Stage Role of Radiation Therapy

MetastaticNon-Small Cell Lung Cancer

IV Palliative Radiation Therapy

MetastaticSmall Cell

Lung Cancer

Extensive Palliative Radiation Therapy

Palliative Radiation Therapy

• Treatment of areas of the body where the cancer is causing a problem

• Short course of radiation therapy to:– Relieve bothersome symptoms– Improve quality of life

• 1-2 weeks of daily radiation treatments

For Patients with Metastatic Lung Cancer

Palliative Radiation TherapyExamples

• Bone metastases causing pain

• Lung tumors causing cough or shortness of breath

• Brain metastases causing brain swelling and neurological symptoms

Palliative Radiation TherapyExample: Cancer in the Bone Causing Pain

Very Effective in Relieving Bone Pain from Cancer

Palliative Radiation TherapyExample: Lung Tumor Causing

Breathing ProblemsTumor Pressing

on Airway Airway

LeftLung

RightLung

Radiation Field

Tumor Pressing

on Airway

Palliative Radiation TherapyExample: Tumors in the Brain

Whole Brain Radiation Stereotactic RadiosurgeryFocal, “Pinpoint” Radiation

Radiation Technology: Radiation Technology: Too Many KnivesToo Many Knives

• Different radiation treatments can be delivered using different machines/technology platforms.

• Each platform has strengths/weaknesses.• All platforms have strong MARKETING.

Cyberknife X-Knife Gamma-Knife Kitchen Knife

Summary• Radiation therapy plays an important role in the

management of lung cancer• Long course (5-7 weeks) conventional radiation

therapy can be used with surgery and chemotherapy as curative treatment of locally advanced cancers

• Stereotactic body radiation therapy is a promising new treatment for stage I non-small cell lung cancer

• Short course (1-2 weeks) palliative radiation therapy can be useful for symptom control in patients with more advanced disease