Radiotherapy: New developments in the treatment of lung cancer

August 8, 2017 | by City of Hope

Radiation is an important part of the cancer treatment toolkit, and it can be effective in treating lung cancer.

Helen Chen, M.D., a radiation oncologist in the Department of Radiation Oncology at City of Hope, recently discussed the pros, cons and latest developments in radiotherapy for lung cancer.

How does radiation work?

To treat cancer, medical teams have three broad options, explained Chen. Surgery cuts out tumors. Chemotherapy uses medications to attack cancer cells. “And then there’s radiation, which is actually more similar to surgery,” she said.

Radiation kills cancer cells by damaging their DNA. But unlike chemotherapy, which affects cells throughout the body, radiation targets just one area of the body, either where the tumor is or where it was removed by surgery. “You can think of radiation as high-energy X-rays. It’s a high-energy beam that can penetrate the deeper tissues,” said Chen.

The first critical step of radiation therapy is good planning. Lung cancer tumors vary in size, shape and location from patient to patient. Before administering radiation, oncologists use CT (computed tomography) scans to see exactly where the tumor is located, how it is shaped and even how it moves as a patient breathes.

Then they create a treatment plan that delivers beams of radiation from multiple angles to the precise spot they want to treat. With current technology, radiation oncologists can deliver that radiation to within millimeters of their target, said Chen. “The key thing for radiation is to treat the tumor or the area of the cancer, but avoid giving radiation to healthy tissue.”  

Weighing risks and benefits

Patients often express concern about radiation therapy, since exposure to radiation can increase the risk of developing cancer. That’s true for the radiation exposure that you get from flying in an airplane, having an X-ray or being treated with radiotherapy.

But, according to Chen, the risk that any individual will develop a new cancer from radiation is relatively small, while the chance of curing existing cancer is often much higher.

When we weigh the risk versus benefits, if you have a very high chance of curing cancer versus a very tiny risk of causing cancer, you’re going to give the radiation to cure the cancer,” said Chen.

Modern techniques also reduce risks by focusing the radiation dose on a small area of the body.

Those targeted treatments help to minimize side effects, though some are unavoidable. If a patient’s lung tumor is right next to the esophagus, for example, he or she might experience some temporary discomfort that feels like heartburn when swallowing. In many cases, such side effects can be managed with medications.

Radiosurgery for early-stage lung cancer

Radiotherapy for lung cancer has come a long way in recent years. Traditionally, a person being treated for lung cancer might have received a dose five days a week for six or seven weeks, said Chen. But a newer approach called stereotactic body radiation (SBRT) is changing that. Also known as radiosurgery, SBRT delivers the same dose of radiation in less than a week, often wiping out a lung tumor without the need for surgery.

SBRT is only an option for people with early-stage lung cancer, but for those patients the treatment is as effective as surgery, said Chen. That makes it a great option for people who are not good candidates for surgery, such as the elderly or those with other health problems. “What this means is patients with early stage lung cancer can have SBRT treatment and, in less than a week just laying on the radiation table, have a chance of curing their cancer [with results comparable to surgery],” she said.

Such options can help many people with lung cancer get back on their feet sooner, said Chen. “You don’t want somebody spending all their time in the hospital or a clinic. You want to give them their treatment and then they’re out of here, living their life.”

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