Sunday, March 3, 2024

Radiation Treatment For Lung Cancer

Travelling To Radiotherapy Appointments

Stereotactic body radiation therapy (SBRT) for lung cancer

You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.

You can ask the therapy radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.

Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.

The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. It is only for people who would struggle to use public transport and have no access to a car.

Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.

Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.

How Radiotherapy Is Given

The 3 main ways that radiotherapy can be given are:

  • conventional external beam radiotherapy beams of radiation are directed at the affected parts of your body.
  • stereotactic radiotherapy a more accurate type of external beam radiotherapy where several high-energy beams deliver a higher dose of radiation to the tumour, while avoiding the surrounding healthy tissue as much as possible.
  • internal radiotherapy a thin tube is inserted into your lung. A small piece of radioactive material is passed along the catheter and placed against the tumour for a few minutes, then removed.

For lung cancer, external beam radiotherapy is used more often than internal radiotherapy, particularly if it’s thought that a cure is possible.

Stereotactic radiotherapy may be used to treat tumours that are very small, as it’s more effective than standard radiotherapy alone in these circumstances.

Internal radiotherapy is usually used as a palliative treatment when the cancer is blocking or partly blocking your airway.

How Much Radiation Therapy Costs

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for information on organizations that may help.

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Targeted Therapy With Radiation Therapy For Localized Nsclc

Many targeted therapies have been integrated into the treatment of localized NSCLC. While the data are much more limited than for the metastatic setting, targeted therapies have been used in combination with or concurrently with radiation therapy. The majority of this data are in conjunction with radiation therapy in the setting of locally advanced NSCLC classically treated with concurrent chemotherapy and radiation.

Preclinical data have shown biologic rationale for combining EGFR inhibitors and radiation therapy. Cetuximab has been combined with chemotherapy and radiation in treatment of locally advanced NSCLC in both phase II and phase III trials . In two sequential Radiation Therapy Oncology Group trials, cetuximab was combined with carboplatin/paclitaxel and radiation therapy for stage IIIA/IIIB lung cancer. While the median survival and 24-month OS achieved in the phase II study of cetuximab and concurrent chemoradiation were longer than any previously reported by the RTOG , the randomized phase III trial RTOG 0617 failed to show a benefit to the addition of cetuximab to chemoradiation in an unselected population . Among all patients, median OS in patients randomized to cetuximab was 25.0 vs. 24.0 months among those not receiving cetuximab . However, in a planned analysis of the association of EGFR expression and outcome, among patients with an EGFR H score of 200 or higher, cetuximab use was associated with improved OS .

Treatment By Stage Of Nsclc

Harnessing the Power of Radiation Therapy to Treat Cancers

Different treatments may be recommended for each stage of NSCLC. Below is a general overview. Your doctor will work with you to develop a specific treatment plan based on the cancer’s stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this page. Clinical trials may also be a treatment option for each stage.

Stage I and II NSCLC

In general, stage I and stage II NSCLC are treated with surgery. Surgeons cure many people with an operation. Before or after surgery, a patient may also meet with a medical oncologist. Some people with a large tumor or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy. Chemotherapy may be given before the surgery, called neoadjuvant chemotherapy or induction chemotherapy. Chemotherapy may also be given after surgery, called adjuvant chemotherapy, to reduce the chance that the cancer will return.

For patients with stage I or II lung cancer who cannot or prefer not to undergo surgery, radiation therapy, such as stereotactic ablative radiotherapy or stereotactic body radiotherapy , may be offered.

Stage III NSCLC

More than 30,000 people are diagnosed with stage III NSCLC every year, and there is no single best treatment for all of these patients. Treatment options depend on the size and location of the tumor and the lymph nodes that are involved.The options generally include:

  • Radiation therapy

  • Targeted therapy

Metastatic or stage IV NSCLC

Treatment for brain metastases

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Role Of Radiation In Early Stage And Locally Advanced Non

Definitive radiation therapy has been part of the standard of care for patients with locally advanced NSCLC for almost 5 decades. Combined modality therapy with chemoradiation became the preferred treatment of these patients based on multiple clinical trials showing improved survival . Conventionally fractionated radiation therapy remains the standard, and attempts at dose escalation have failed to show a benefit in this patient population . Newer technologies such as intensity modulated radiation , image guided radiation therapy, and proton therapy are increasingly being utilized or studied to lower rates of toxicity with combined modality therapy.

SBRT has also begun to be used more frequently in patients with oligometastatic disease, including lung, liver, and bone metastases. Recent data has shown excellent control rates with encouraging progression free survival in patients with oligometastatic NSCLC . Conventionally fractionated radiotherapy, in combination with chemotherapy, can also be considered in patients with oligometastatic disease not amenable to treatment with SBRT and may improve survival in a select subset of patients with minimal extrathoracic disease .

How Radiation Is Used With Other Cancer Treatments

For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

When radiation is combined with surgery, it can be given:

  • Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
  • During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
  • After surgery to kill any cancer cells that remain.

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Common Types Of External Beam Radiation Therapy For Lung Cancer

When treating small cell lung cancer and non-small cell lung cancer , radiation can be delivered with one of several external beam technologies such as:

  • Intensity Modulated Radiation Therapy – This is a popular form of external beam radiotherapy because it uses images from CT scans to precisely plan where the radiation beams will target, helping reduce damage to healthy tissue by focusing the dose on the tumor.

  • Stereotactic Body Radiation Therapy – this type of radiation therapy focuses high doses of radiation on small areas in or around the tumor to minimize damage to surrounding tissue.

Smoking And Lung Cancer

Radiation Therapy for Lung Cancer – Short Video

Smoking greatly increases your chances of developing lung cancer. Other risk factors include exposure to substances like second-hand smoke, arsenic, some organic chemicals, radon, asbestos, air pollution and tuberculosis.

If you havent already quit smoking, the potential health benefits begin immediately.

  • For patients with lung cancer, quitting smoking makes treatment more effective.
  • Quitting smoking also reduces the risks of infections, such as pneumonia, improves breathing, and reduces the risks associated with surgery.
  • To learn how to quit, talk to your doctor or visit .

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How Small Cell Lung Cancer Is Treated

In cancer care, different types of doctors often work together to create a patients overall treatment plan that combines different types of treatments. This is called amultidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Chemotherapy is the primary treatment for SCLC. Additional treatment depends on whether or not it is limited stage SCLC or extensive stage SCLC . For limited stage SCLC, chemotherapy is often combined with radiation therapy to the chest. For extensive stage SCLC, chemotherapy is often combined with immunotherapy. Radiation therapy can also be an option for people with extensive stage SCLC that could spread to the brain or has already spread to the brain. Surgery is not usually an option for people with SCLC, except for in a small number of people with very limited stage SCLC. These treatments are described below, followed by an outline of treatment options by stage. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

How Do I Prepare For Lung Cancer Radiation Therapy

Radiation treatment requires preparation on the part of you and your medical team. Thats because radiation dosages must be precisely targeted to maximize their curative effect while minimizing damage to surrounding tissues. This is particularly critical with external-beam radiation. Planning may involve:

  • Radiation simulation: During a simulation procedure, your physician will mark your body to improve positioning for the radiation session. If youre undergoing brachytherapy, your medical team may also insert marker pellets in the tumor bed to guide introduction of the radioactive isotopes.
  • Planning scans: Your physician will take CT scans of your lung and chest cavity.

This preparatory work enables your physician to select the type and dosage of radiation best suited to treating your cancer.

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Are There Any New Developments In Treating My Disease

  • Less invasive surgical methods are under study. They require a much smaller incision and allow the patient to be up within hours after surgery ends.
  • Angiogenesis inhibitors are agents that prevent new blood vessels from forming in growing cancers and may shut off the tumors blood supply. This remains an experimental approach but it is promising in part because it seems to cause very few side effects.

Can Lung Cancer Be Treated With Radiation

New tool improves 4D radiation therapy for lung cancer

Below is a table of current, common radiation therapy techniques used to treat lung cancer either as a primary or secondary treatment.

Type of Radiation Therapy
Whole-brain radiation therapy to prevent the spread of tumors.
Stereotactic ablative radiotherapy , also known as stereotactic body radiation therapy High doses of radiation pinpointed to focus on tumors while limiting dose to surrounding areas.
Stereotactic radiosurgery High doses of radiation pinpointed to focus on lung cancer tumors spread to the brain and spinal cord.
3-dimensional conformal radiation therapy , also known as intensity-modulated radiation therapy A special computer maps the tumor, then shapes beams of radiation to hit it from multiple sides. Reduces damage to normal cells.

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Inoperable Lung Cancer Diagnosis

Symptoms like a nagging cough, chest pain, and shortness of breath often don’t start until lung cancer has spread. The lack of early symptoms is why many people aren’t diagnosed until their cancer is inoperable.

Lung cancer is usually first suspected on imaging, an xray or lung ct. To make a certain diagnosis your doctor will need small sample of the mass. Depending on where in the lung it is located it may be collected by bronchoscopy or Video-assisted thoracoscopic surgery if it is located closer to the chest wall rather than inside or close to a large airway which is more accessible by bronchoscopy.

A bronchoscopy involves using a thin tube with a light on the end that lets your doctor see inside your lungs and remove a small piece of tissue. A lab then examines the tissue sample to see if it’s cancer.

Other tests can show where in your body the cancer has spread and help your doctor decide whether surgery is an option for you:

Continued

Sbrt For Central Tumors

In the seminal phase 2 study13 using SBRT for inoperable early stage lung cancer, a threefold increased risk of grade 3 to 5 toxicity for centrally located tumors versus peripheral tumors was noted. The radiation fractionation used in this study was 18 Gy per fraction, and three fractions were given. This led to exclusion of centrally located tumors receiving SBRT in the Radiation Therapy Oncology Group protocols.

In another study,14 32 patients diagnosed as stage I, T1N0 or T2N0, resectable NSCLC were treated with body frame-based fractionated SBRT. The 1- and 2-year actuarial local tumor control rates were both 85.3%. Overall survival was 70.9% at 1 year and 38.5% at 2 years, and survival was not correlated with SBRT dose. Of nine patients with centrally located tumors, three experienced grades 3 to 5 pulmonary toxicities. Eight patients showed partial or complete bronchial stricture and secondary loss of normal lung volumes the median time to bronchial stricture was 20.5 months.

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What Is Radiation Treatment For Lung Cancer

Radiation therapy, or radiotherapy, uses powerful, high-energy X-rays to damage cancer cells. The treatment is delivered using:

External radiation : A machine outside the body aims a beam of X-rays directly at the cancer and surrounding tissue. External radiation is the most commonly used radiation treatment for lung cancer.

Internal radiation : Physicians deliver radiation directly to the site of the cancer with an image-guided procedure. Brachytherapy delivers a high dose of radiation to a small area.

Physicians use radiation therapy for lung cancer in many ways, including:

  • As a primary treatment, given alone or along with chemotherapy
  • Before surgery, to shrink a tumor
  • After surgery, to kill any cancer cells left behind
  • To relieve symptoms, such as pain, bleeding or airway blockage caused by the cancer
  • For metastasis , to lower the chances of lung cancer growing outside the lungs

What Is Radiation Therapy And When Is It Used For Lung Cancer Treatment

Lung Cancer â Radiation Therapy Treatment

Radiation therapy or radiotherapy are high energy X-rays which kill cancer cells. Radiotherapy can be used in all stages of lung cancer:

  • Stage I and II: radiotherapy is usually used alone.
  • Stage III: radiotherapy is commonly used in combination with chemotherapy.
  • Stage IV: radiotherapy is used to treat tumours within the lung, while also used on areas where cancer may have spread outside the lung to improve pain or provide control.

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How Internal Therapy Is Administered

For internal therapy, you usually need to be admitted to the hospital for your implant placement. This requires a brief operation with general or local anesthesia. Your healthcare provider will use a tube and an imaging tool to place the implant near your tumor.

How long the implant stays inside your body varies, depending on the dose being administered:

  • High-dose brachytherapy: With high-dose therapy, the implant may be left in for several minutes at a time while a large dose of radiation is emitted. Treatments may be repeated twice a day over a few days or once a day over the course of a few weeks. The application tube may be left in place until the series of radiation treatments are complete.
  • Low-dose brachytherapy: With low-dose brachytherapy, an implant may be left in for one or more days to allow it to give off low doses of radiation the entire time. Some smaller implants are never removed, but will stop emitting radiation after several weeks.

Radiation Therapy For Lung Cancer: The Ucla Health Advantage

At UCLA Health, we provide effective radiation treatments that target lung cancer and focus on your health, wishes and goals. Youll also benefit from:

Latest radiation therapies: We weave together leading-edge technology and compassionate care to provide safe, effective and personalized treatment. Learn more about radiation oncology at UCLA Health.

Lung cancer expertise: Our radiation oncology team specializes in thoracic radiation. With a high volume of patients, we offer experience and expertise you wont find elsewhere. Meet our expert team.

Team-based care: Your radiation oncologist works with specialists from all areas of lung cancer care. Together they develop and coordinate a treatment plan tailored to you.

Care close to home: UCLA Health offers cancer care at more than 25 locations throughout Southern California. Find a cancer care location.

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