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How is Radiation Therapy Used to Help Lung Cancer Patients?

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A presentation by Ray Mak, MD, Department of Radiation Oncology at Dana-Farber Cancer Institute.

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How is Radiation Therapy Used to Help Lung Cancer Patients?

  1. 1. How is Radiation Therapy Used to Help Lung Cancer Patients? Ray Mak, M.D. Department of Radiation Oncology
  2. 2. Overview 1. Role of Radiation Therapy in Non-Small Cell Lung Cancer 2. Role of Radiation Therapy in Small Cell Lung Cancer 3. Conventional Radiation Therapy 4. Stereotactic Body Radiation Therapy 5. Palliative Conventional Radiation Therapy 6. Summary
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Conventional Radiation Therapy Curative Treatments Category Stage Role of Radiation Therapy Localized 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
  7. 7. 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 by Pathologist ?More treatment
  8. 8. Post-operative Radiation Therapy For Patients with Locally Advanced (Stage IIIA) Non-Small Cell Lung Cancer Surgery Review by Pathologist High Risk Features + Chemotherapy 5-6 Weeks of Daily Radiation Therapy
  9. 9. Curative Radiation Therapy + 6-7 Weeks of Daily Radiation Therapy Chemotherapy Monitoring of Response With Scans Over Months For Patients with Inoperable Locally Advanced Non-Small Cell Lung Cancer or Limited Stage Small Cell Lung Cancer
  10. 10. Role of Radiation Therapy Stereotactic Body Radiation Therapy Category Stage Role of Radiation Therapy Localized Non-Small Cell I Stereotactic Body Radiation Therapy Locally Advanced III Curative, Conventional Radiation Therapy (Preoperative, Postoperative, or Without Surgery) Metastatic IV Palliative Radiation Therapy
  11. 11. 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
  12. 12. Stereotactic Body Radiation Therapy • Requires high tech planning and imaging • Very high tumor control rates (~90%) Live View of Moving Tumor Through the Radiation Portal Courtesy Ross Berbeco
  13. 13. Role of Radiation Therapy Palliative Radiation Therapy Category Stage Role of Radiation Therapy Metastatic Non-Small Cell Lung Cancer IV Palliative Radiation Therapy Metastatic Small Cell Lung Cancer Extensive Palliative Radiation Therapy
  14. 14. 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
  15. 15. Palliative Radiation Therapy Examples • Bone metastases causing pain • Lung tumors causing cough or shortness of breath • Brain metastases causing brain swelling and neurological symptoms
  16. 16. Palliative Radiation Therapy Example: Cancer in the Bone Causing Pain Very Effective in Relieving Bone Pain from Cancer
  17. 17. Palliative Radiation Therapy Example: Lung Tumor Causing Breathing Problems Tumor Pressing on Airway Airway Left Lung Right Lung Radiation Field Tumor Pressing on Airway
  18. 18. Palliative Radiation Therapy Example: Tumors in the Brain Whole Brain Radiation Stereotactic Radiosurgery Focal, “Pinpoint” Radiation
  19. 19. 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
  20. 20. 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

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