Radiation oncologist Dr. Chris Loiselle reviews the possibility of re-treating with radiation for lung cancer, typically using stereotactic technique, in a previously irradiated field.
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Reirradiation of lung cancer is an area where we discuss a lot with patients, the risks and benefits, and think a lot about the unique situation that each patient is finding themselves in. I think it’s often an area too where many people are told by their physicians that once they've had radiation, they can’t have it again, and that is not true, generally. We often will consider doing reirradiation, or a second course of radiation; we’ll often do reirradiation with stereotactic techniques, like the CyberKnife, to really minimize any collateral damage, but it is a careful discussion of risks and benefits.
We think about doing reirradiation when we see patients who, typically, are in one of two circumstances. The first one being a patient who has an early stage disease treated with surgery or radiation, and they have a recurrence which, typically, is not operable. In this situation, we are treating with curative intent, and in the setting of curative intent, we may be willing to accept some increased risk depending on the certain circumstances in an effort to potentially cure a life-threatening lung cancer.
On the other side of reirradiation, the circumstance that we see most is a patient who has radiation, either to a primary site or perhaps to a metastatic site in the body, and they recur there, and it’s causing problems — it’s causing spinal cord compression, it is compressing an airway, and we think about this as a multidisciplinary team. We think about all options: we think about chemotherapy, targeted therapy, surgery, but sometimes when surgery or chemotherapy or systemic therapy are not a good option, and reirradiation, though it carries some risks, is an option, we move forward with a mutual understanding between ourselves and our patients about what we’re getting into, and we are looking toward doing the best that we can — again, sometimes thinking about understanding increased risks.