Radiation Therapy

Here's a text-heavy but still brief summary "slidedoc" of what I would consider to be the core principles of managing locally advanced, or stage III, non-small cell lung cancer (NSCLC). This is a heterogeneous population that accounts for about 40% of the patients newly diagnosed with NSCLC, with some having far more extensive and bulky disease than others.  Though individual treatment recommendations should be made by the physicians directly reviewing the details of a patient's case, the key principles still govern the overall plan.

There is a principle in management of lung cancer that some patients who have a very limited degree of metastatic disease or progression after a good response may do unusually well with local treatment, such as radiation or surgery, for the isolated area(s) of disease that are metastatic or growing.

Why do we care about lymph nodes when staging lung cancer?

Dr. David Gerber, University of Texas-Southwestern, reviews a Swiss study comparing tri-modality therapy with chemoradiation followed by surgery to chemo followed by surgery for stage IIIA NSCLC.

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Dr. David Gerber, University of Texas-Southwestern, reviews results from RTOG 0617 that help clarify the optimal dose of radiation for stage III unresectable NSCLC.

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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)?

I've mentioned in posts in the past about the settings in which local therapy might be appropriate for someone even when we know the cancer is advanced/metastatic.  Here's a brief video that discusses some of these issues, including a situation in which the local treatment isn't specifically aimed at addressing a symptom, as is the usual reason for treating with local therapy for metastatic cancer, but is rather what I'd consider the "Get the Lead Runner" strategy:

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I'm interested in your thoughts.

Here's the second half of the presentation by Dr. Gerard Silvestri, expert pulmonologist and critical care specialist at the Medical University of South Carolina in Charleston, on pulmonary complications from lung cancer treatment.

Like Charlie Brown always thinking that this time will be different when he tries to kick the football without Lucy pulling it away, we get lulled into thinking that we know the intuitive, obvious answer in medicine without really testing it, only to find that our assumption was wrong yet again.

For non-small cell lung cancer patients with multiple brain metastases, the standard approach of whole brain radiotherapy is not necessarily standard for each and every patient. Each patient's specific situation may sometimes be best approached with various combinations of surgery, radiation, medical/systemic therapy, and non-cancer directed treatment.