Radiotherapy of lung cancer

01/2019

Doc. MUDr. Milada Zemanová, Ph.D.

Onkologická klinika 1. LF UK a VFN, Praha

SUMMARY

In the treatment of pulmonary cancer, radiotherapy is a basic method that has demonstrated therapeutic benefit in both radical and palliative indications in up to 76% of all patients. In the Czech Republic, the proportion of patients with bronchogenic carcinoma treated with radiotherapy does not exceed 25%. In the case of clinically inoperable non-small cell lung cancer (NSCLC) in stage I, stereotactical radiotherapy is the method of choice which allows local control of the disease up to 90% of the patients after three years while it's efficiency is comparable to the surgery with better tolerance. Postoperative radiotherapy is appropriate for the affected mediastinal lymph nodes. In locally advanced inoperable NSCLC, the standard of concomitant chemoradiotherapy is co-administered with chemotherapy based on the two platinum-containing cytostatics. No flat-rate escalation over 60 Gy/6 weeks for increased toxicity with higher risk of death has been demonstrated. Flat-rate escalation over 60 Gy/6 weeks has not been proven useful as it increases the toxicity and the risk of death. Technical innovations, such as beam-modulated radiotherapy, image-based radiotherapy, or breathing movement monitoring over time, improve treatment outcomes. Technical innovations, such as beam-modulated radiotherapy, image-based radiotherapy, or breathing movement monitoring over time, improve treatment outcomes. In small-cell carcinoma, at the stage of limited disease, the most effective is concomitant chemoradiotherapy, starting at the latest from the third cycle of chemotherapy, at a dose of 66 Gy/33 fractions or twice daily for 3 weeks to a dose of 45 Gy. Radiotherapy is also recommended at the extensive disease stage as a consolidation treatment after chemotherapy with a very good response. In the treatment of small cell carcinomas, preventive brain irradiation is recommended as standard, although recent studies, as an alternative, include careful and frequent magnetic resonance imaging (MR) and early treatment in an asymptomatic stage. In NSCLC, preventive irradiation reduces the proportion of patients with brain metastasis from 30% to 8%, but survival prolongation has not been demonstrated.

KEY WORDS

lung cancer, concomitant chemoradiotherapy, stereotactic body radiotherapy, prophylactic cranial irradiation