Dr. Ross Camidge, University of Colorado, discusses management of CNS progression for ALK-positive NSCLC including monitoring frequency and preferences between systemic and radiation therapy.

Dr. David Harpole, Duke University Medical Center, defines the concept of mediastinal node sterilization and its use after neoadjuvant therapy.

Dr. Chris Loiselle, radiation oncologist, describes stereotactic body radiation therapy (SBRT) as a helpful and increasingly favored treatment option for sicker, “medically inoperable” patients with early stage lung cancer.

Managing brain metastases is a big concern for lung cancer patients. The doctors discuss the drawbacks of whole brain radiotherapy and the fact that there are still unknowns regarding more targeted stereotactic radiosurgery.

[powerpress]

Here is a brief and basic summary of the concept of why we're concerned not only about the cancer we can see but the potential cancer we can't.

The Radiation Therapy Oncology Group (RTOG) has been working on a large randomized trial in patients with stage III, locally advanced, unresectable NSCLC that asked two key questions:

1) is the best dose of radiation the "old" standard of 60 Gray (Gy), over about 6 weeks, or a higher dose of 74 Gy that has been found to be feasible?

2) Is there a value in adding weekly Erbitux (cetuximab), the antibody to the epidermal growth factor receptor (EGFR), along with weekly carboplatin/Taxol (paclitaxel) and concurrent chest radiation therapy (RT)?

Introduction

Thank you to member Craig for asking some excellent questions in response to my Highlights of 2011 webinar.  Thank you also to Dr. West, who emailed me to comment more on the idea of radiation for cells with acquired resistance.

We’ve spoken at length about EGFR and related mutations such as EML4/ALK and ROS1 on GRACE.  For those who are not familiar with these subjects, I will refer you to my webinar for a summary on the most recent data on EGFR, EML4/ALK and ROS1:

Dr. Quynh Le, radiation oncologist and Professor at Stanford University, was kind enough to participate in our NSCLC Patient Education Forum. She spoke on the topic of emerging treatment options using radiation for early stage NSCLC. The new work she's describing on stereotactic body radiation therapy (SBRT) is looking promising enough that it's being considered increasingly as a very strong choice for people with localized lung cancer but who aren't good candidates for surgery or are disinclined to pursue it.

Ask and ye shall receive! The leading requiest for a video podcast presentation was for a summary of the subject of locally advanced, unresectable stage III NSCLC. Here you go:

[powerpress]

Sorry it's a little rushed, but it's a struggle to do a topic justice with a 10 minute limit (the most YouTube accepts). In the future, we'll try to divide bigger topics into two podcasts if it's going to require cramming into a 10 minute interval. It may help for you to have the images and transcript available, so here they are:

In prior posts I've described the special circumstance of a Pancoast tumor, which is a tumor at the top of the lung that tends to grow into the spine, ribs, and sometimes the nerves going to the arm. These cases are a major challenge because surgery is often something to consider, because they often grow locally more than speading to the rest of the body, but surgery can be a special challenge because the vertebrae are generally not considered to be resectable.