Dr. Vivek Mehta, radiation oncologist, reviews the basic principles and treatment approach for limited stage small cell lung cancer, which combines chest radiation with concurrent chemotherapy.
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Small cell cancer of the lung is a type of lung cancer. Small cell cancer of the lung come in two shapes and sizes, if you will. Limited stage disease is cancer that’s affecting only the chest, or what we think about in radiation oncology as sort of “the box,” if you will, and extensive stage disease is small cell cancer that started in the chest, that spread to other parts of the body — for example, the liver, the bone, or other tissues.
The treatment for limited stage disease is often to use a combination of chemotherapy and radiation treatment. The chemotherapy goes throughout your body, killing not only the cancer that you can see, but the cancer that you also could be hiding somewhere that’s too small to detect. The radiation is directed at the bulky cancer that’s within the chest. The radiation treatment is delivered Monday through Friday, generally over a period of five or six weeks. The treatment is used in combination because, when you do radiation alone, you don’t kill most of the cancer that’s hiding elsewhere in the body — when you do chemotherapy alone, there’s a high risk of the cancer coming back in the region that it started. When you combine the radiation and chemotherapy together, you have a much greater chance of eradicating every last cell. Eradicating the last cell is the hope in this whole cancer, because you’re trying to cure these patients.
We’ve done studies in terms of the timing of when it’s best to give the radiation, relative to the chemotherapy, and what we’ve learned is that, if you can get the radiation and the chemotherapy started at the same time early on, that’s actually more effective than doing chemotherapy first and having the radiation at the tail end of treatment. So, our preference here at this center is to treat everybody with upfront chemoradiation, when it’s possible, in patients that can tolerate it, with limited stage disease. We’re hoping, again, to try to cure as many of these patients as we possibly can.