How is Radiation Therapy Used to Help Lung Cancer Patients?
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Transcript of How is Radiation Therapy Used to Help Lung Cancer Patients?
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How is Radiation Therapy Used to Help
Lung Cancer Patients?Ray Mak, M.D.
Department of Radiation Oncology
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Palliative Radiation TherapyExamples
• Bone metastases causing pain
• Lung tumors causing cough or shortness of breath
• Brain metastases causing brain swelling and neurological symptoms
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Palliative Radiation TherapyExample: Cancer in the Bone Causing Pain
Very Effective in Relieving Bone Pain from Cancer
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Palliative Radiation TherapyExample: Lung Tumor Causing
Breathing ProblemsTumor Pressing
on Airway Airway
LeftLung
RightLung
Radiation Field
Tumor Pressing
on Airway
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Palliative Radiation TherapyExample: Tumors in the Brain
Whole Brain Radiation Stereotactic RadiosurgeryFocal, “Pinpoint” Radiation
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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
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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