In this audio interview with Dr. Vivek Mehta, Radiation Oncologist and Director of the Center for Advanced Targeted Radiotherapy at Swedish Cancer Institute, Dr. Mehta explains current and emerging new radiation techniques, as well as the current state of radiation therapy to treat patients with “medically unresectable” early stage NSCLC, or patients who decline the option of surgery for resectable disease.  He also covers side effect challenges with radiation and particularly when chest radiation is combined with chemotherapy.  In addition to the audio portion, there are a few figures synchronized with the discussion in the video version, or you can just download the figures as a separate pdf file.  The transcript is also provided below.

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   There some patients with early stage lung cancer that are not good candidates for standard lung surgery because of their underlying poor lung function.  A standard lung surgery typically involves removing the entire lobe of the lung that contains the cancer.  Unfortunately, for some patients with underlying COPD or emphysema – they can’t afford to lose a complete lobe of the their lung.  In this situation, some surgeons have performed more limited surgery including doing a “sub-lobar” resection.  The results for patients who have this limited surgical resection are not nearly as good as patients that have a complete lobectomy.  In some series, the incidence of local recurrence can be as high as 20-40% if only a limited surgery is performed.  The problem with these limited surgeries is that the surgeon often leaves microscopic disease behind along the edges of the surgical specimen.  In other tumor types, the surgical margins are evaluated carefully and more tissue is often resected if the margins are involved.  In lung cancer, evaluation the margins from the surgery specimen is more difficult, and the incidence of additional microscopic cells left in the area around the resection is probably quite high.  This probably explains while the recurrence rate for small tumors is quite low with a conventional lobectomy, and much higher when less tissue is removed in a sub-lobar resection.

   Brachytherapy means the use of locally placed radiation.  In this case, radioactive seeds are placed in and around the surgical suture line after the surgery is complete.  These seeds are sewed into the lung tissue or sewed into a mesh fabric that is then placed on the lung in the area that is at highest risk. 

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Radiation pneumonitis is defined as inflammation in the lungs following radiation, and it is a common problem we see in patients who have received recent radiation therapy for lung cancer. It typically occurs several weeks or even a few months after radiation has been completed, with symptoms of shortness of breath, cough, and sometimes a fever. Chest x-rays or CT scans show an infiltrate, which is a cloudy area in the lung tissue that looks like pneumonia. It is very hard to determine how commonly it occurs, because 1) the symptoms are often presumed to be due to lung cancer or pneumonia and therefore may not be recognized as being from pneumonitis, 2) people who have the radiologic findings but minimal or no symptoms will not be recognized as having it, and, 3) patients who develop progressive or recurrent cancer may actually decline too quickly to develop it. Overall, the estimates of moderate to severe pneumonitis are in the 5-20% range in most recent studies with full dose radiation alone or radiation with chemotherapy. Although it often resolves, with or without any treatment, severe cases can be fatal. Read the rest of this entry »