Stereotactic Radiotherapy: Leading-edge Treatment for Lung Cancer

June 4, 2018 | by Kevin Chesley

Helen Chen, M.D., Department of Radiation Oncology Helen Chen, M.D.
One of the most exciting new treatments for lung cancer is stereotactic radiotherapy. This method uses multiple, precisely targeted high-dose beams of radiation to treat a patient’s tumor. Helen Chen, M.D., a board-certified assistant clinical professor in the Department of Radiation Oncology at City of Hope, explains this leading-edge form of radiation treatment.

The Stereotactic Radiotherapy Difference

For early-stage lung cancer, a new choice in radiation therapy has emerged over the last decade: SBRT, or stereotactic body radiation therapy. “For decades, radiation for lung cancer has been given in small doses over six or seven weeks, Monday through Friday. But SBRT treats lung cancer in less than a week, in just three to five treatments,” Chen, a radiation oncologist, explained. “A much higher dose is delivered while the patient just lies on a table, breathing normally, watching TV and relaxing. All with a 97 percent chance of eradicating the tumor, and I actually haven’t seen side effects. I’ve been amazed by this.”
SBRT works by using several beams of various intensities aimed at different angles to precisely target the tumor. It has been found to be a much more effective method than traditional definitive radiation treatment, with far fewer side effects and little or no damage to surrounding tissue. It kills cancer cells by damaging their DNA.

Finding the Target

Due to its precise aim, the first step in stereotactic radiation treatment for lung cancer is locating the tumor’s exact size and shape. “Everybody has a different shape of tumor, different location, different size. Our dedicated CT scanner performs what we call a four-dimensional CT scan — we already know we have three dimensions — but there’s a fourth dimension of motion. When a patient is breathing, a lung tumor moves,” Chen said.
After the scan is complete, Chen and a team of physicists and dosimetrists create a treatment plan that outlines the multiple angles needed to fire radiation beams to avoid healthy tissue and send treatment straight to the cancerous cells.

Side Effects of Radiation Therapy

Each part of the body is capable of withstanding a different level of radiation. “There are very strict guidelines to be followed on how much radiation can be delivered to the spinal cord, esophagus or heart, for example,” Chen said.
Potential side effects may be short-term, and depend on where the treatment is given. “If a tumor is next to the esophagus, a person might feel heartburn while swallowing. I mitigate that with medications to relieve the discomfort,” Chen said.
But there are longer-term side effects to worry about as well. The greatest fear patients have about treating their cancer with radiation is that the radiation will cause a new cancer months or years later. Chen tries to assuage that fear. “Any kind of radiation — the radon from an airplane, a chest X-ray — has a finite chance of developing cancer in a patient. It’s basically a statistical issue, a math issue. If the chance of developing cancer is remote, very miniscule, we weigh the risk versus benefits.”

The Future for Radiotherapy

Chen hopes that even further advancements are on the way for advanced lung cancer. “That’s where City of Hope is making strides — in not only treating these patients, but actually creating drugs that go from the lab to the clinical trial to the patient, right in their own community. That’s key when talking about someone with cancer. You want to give them their treatment and then they’re out of here, living their life.”
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