A presentation by Ray Mak, MD, Department of Radiation Oncology at Dana-Farber Cancer Institute.

1. How is Radiation Therapy
Used to Help
Lung Cancer Patients?
Ray Mak, M.D.
Department of Radiation Oncology

2. Overview
1. Role of Radiation Therapy in Non-Small Cell Lung
Cancer
2. Role of Radiation Therapy in Small Cell Lung Cancer
3. Conventional Radiation Therapy
4. Stereotactic Body Radiation Therapy
5. Palliative Conventional Radiation Therapy
6. Summary

3. Radiation Therapy Approaches
for Lung Cancer
Conventional
Radiation Therapy
Stereotactic Body
Radiation Therapy
For Cure
For Palliation
For Cure
of RT Treatment
of RT Treatment
of RT Treatment

4. Role of Radiation Therapy
for Non-Small Cell Lung Cancer
Category Stage Role of Radiation Therapy
Localized I Stereotactic Body Radiation
Therapy
Locally
Advanced
III Conventional Radiation
Therapy
Metastatic IV Palliative Radiation Therapy

5. Role of Radiation Therapy
for Small Cell Lung Cancer
Category Stage Role of Radiation Therapy
Localized Limited Conventional Radiation
Therapy
Metastatic Extensive Palliative Radiation Therapy

6. Conventional Radiation Therapy
Curative Treatments
Category Stage Role of Radiation Therapy
Localized
Non-Small
Cell
III Conventional Radiation Therapy
Localized
Small Cell
Limited Conventional Radiation Therapy
• Small dose per day
• More treatments  longer course
• Higher total dose of radiation to eradicate tumor
• Can mean more side effects
of RT Treatment

7. Pre-operative Radiation Therapy
+
Chemotherapy
5-6 Weeks Daily Radiation Therapy
For Patients with Locally Advanced (Stage IIIA)
Non-Small Cell Lung Cancer
Surgery
Review by
Pathologist
?More treatment

8. Post-operative Radiation Therapy
For Patients with Locally Advanced (Stage IIIA)
Non-Small Cell Lung Cancer
Surgery
Review by
Pathologist
High Risk
Features
+
Chemotherapy
5-6 Weeks of Daily
Radiation Therapy

9. Curative Radiation Therapy
+
6-7 Weeks of Daily Radiation Therapy
Chemotherapy Monitoring of Response
With Scans Over Months
For Patients with Inoperable Locally Advanced Non-Small Cell Lung Cancer
or Limited Stage Small Cell Lung Cancer

10. Role of Radiation Therapy
Stereotactic Body Radiation Therapy
Category Stage Role of Radiation Therapy
Localized
Non-Small Cell
I Stereotactic Body Radiation
Therapy
Locally
Advanced
III Curative, Conventional
Radiation Therapy
(Preoperative, Postoperative,
or Without Surgery)
Metastatic IV Palliative Radiation Therapy

11. Stereotactic Body Radiation Therapy
• For patients with Stage I Non-Small Cell Lung
Cancer who cannot undergo surgery
• A new technique developed in the last 10 years
• High dose, pinpoint radiation to the lung tumor
• 3 to 5 treatments over 1 to 2 weeks

12. Stereotactic Body Radiation Therapy
• Requires high tech planning and imaging
• Very high tumor control rates (~90%)
Live View of Moving Tumor
Through the Radiation Portal
Courtesy Ross
Berbeco

13. Role of Radiation Therapy
Palliative Radiation Therapy
Category Stage Role of Radiation Therapy
Metastatic
Non-Small
Cell Lung
Cancer
IV Palliative Radiation Therapy
Metastatic
Small Cell
Lung
Cancer
Extensive Palliative Radiation Therapy

14. Palliative Radiation Therapy
• Treatment of areas of the body where the
cancer is causing a problem
• Short course of radiation therapy to:
– Relieve bothersome symptoms
– Improve quality of life
• 1-2 weeks of daily radiation treatments
For Patients with Metastatic Lung Cancer

15. Palliative Radiation Therapy
Examples
• Bone metastases causing pain
• Lung tumors causing cough or
shortness of breath
• Brain metastases causing brain
swelling and neurological
symptoms

16. Palliative Radiation Therapy
Example: Cancer in the Bone Causing Pain
Very Effective in Relieving Bone Pain from Cancer

17. Palliative Radiation Therapy
Example: Lung Tumor Causing
Breathing Problems
Tumor Pressing
on Airway
Airway
Left
Lung
Right
Lung
Radiation Field
Tumor
Pressing
on
Airway

18. Palliative Radiation Therapy
Example: Tumors in the Brain
Whole Brain Radiation Stereotactic Radiosurgery
Focal, “Pinpoint” Radiation

19. Radiation Technology:Radiation Technology:
Too Many KnivesToo Many Knives
• Different radiation treatments can be delivered
using different machines/technology platforms.
• Each platform has strengths/weaknesses.
• All platforms have strong MARKETING.
Cyberknife X-Knife Gamma-Knife Kitchen Knife

20. Summary
• Radiation therapy plays an important role in the
management of lung cancer
• Long course (5-7 weeks) conventional radiation
therapy can be used with surgery and chemotherapy
as curative treatment of locally advanced cancers
• Stereotactic body radiation therapy is a promising
new treatment for stage I non-small cell lung cancer
• Short course (1-2 weeks) palliative radiation therapy
can be useful for symptom control in patients with
more advanced disease