Radiotherapy of lung cancer alone and with relation to chemotherapy

05/2019

Doc. MUDr. Milada Zemanová, Ph.D.

Onkologická klinika 1. LF UK a VFN, Praha

SUMMARY

In the treatment of lung cancer, the basic modality is radiotherapy, which has proven therapeutic benefits in both radical and palliative indications in up to 76% of all patients. In the Czech Republic, the proportion of patients with bronchogenic carcinoma receiving radiotherapy has not exceeded 25% in the long term. In the case of clinically inoperable non-small-cell lung cancer (NSCLC) in stage I, the method of choice is stereotactic radiotherapy, which allows local control in more than 80% after three years. Postoperative radiotherapy is suitable in the case of involvement of mediastinal nodes. In locally advanced inoperable NSCLC, the standard of treatment is concomitant chemoradiotherapy given concomitantly with chemotherapy based on a double combination of cytostatics containing a platinum derivative. A flat dose escalation above 60 Gy / 6 weeks has not been shown to be useful, as it increases toxicity with a higher risk of death. Technical innovations such as beam intensity modulated radiotherapy, image-guided radiotherapy or time-tracking of breathing movements bring improvements in treatment outcomes. The clear benefit of proton beam therapy has not been demonstrated. In small cell carcinoma, concomitant chemoradiotherapy is the most effective in the stage of limited disease, starting at the latest from the third cycle of chemotherapy. Radiotherapy is also recommended in the stage of extensive disease as a consolidation treatment after chemotherapy with a very good response. For the treatment of small cell carcinomas, preventive brain irradiation is recommended as a standard, although recent studies have reported close and frequent MRI monitoring and early treatment in asymptomatic as an alternative. In NSCLC, preventive radiation reduces the proportion of patients with the development of brain metastases from 30% to 8%, but this has not been shown to prolong survival.

Key words

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