Developments in radiation techniques for thoracic malignancies (original) (raw)
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Radiotherapy for lung cancer: Clinical impact of recent technical advances
Lung Cancer, 2009
Radiation oncology plays an important role in the curative treatment of patients with lung cancer. New technological developments have enabled delivery of higher radiation doses while better sparing surrounding normal tissues, thereby increasing the likelihood of local control without increased toxicity. Multi-modality imaging enables better target definition, improved planning software allows for correct calculation of delivered doses, and tools to verify accurate treatment delivery are now available. A good example of the results of applying these developments is the high local control rates achieved in stage I NSCLC with stereotactic radiotherapy (SRT). These advances are rapidly becoming available outside academic institutions, and pulmonologists, surgeons and medical oncologists need to understand and critically assess the potential impact of such developments in the routine care of their patients. Aspects of cost-effectiveness of technical innovations, as well as the level of evidence required before widespread clinical implementation, will be addressed.
Liječnički vjesnik
The paper is aimed at approaching radiation therapy methods to physicians of other specialties and pointing to the potential of radiation therapy in the management of lung cancer patients. With the reference to its incidence and mortality rates, lung cancer ranks among the most frequent human malignant tumors. Therapy procedures for lung cancer depend upon tumor histology type, stage of disease and patient general condition. The said parameters therefore determine the application of surgery, radiation therapy and/or chemotherapy. In general, treatment results are usually rather poor, primarily due to lung cancer being the most frequently detected only as locally advanced or metastatic disease. Alike surgery, radiotherapy is a local form of treatment aimed at achieving local tumor control. This curative or palliative form of treatment is either applied alone or in combination with other treatment modalities. Irradiation is usually delivered by high energy photon beams from a telecoba...
State of the Art Radiation Therapy for Lung Cancer 2012: A Glimpse of the Future
Clinical Lung Cancer, 2013
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2017
Lung cancer remains one of the top five cancers worldwide. Around 85% are nonsmall cell lung cancer (NSCLC) and only one‐third present with early stage diseases. Radiotherapy had an important role both in radical and palliative treatment. With advancement in technology, newer techniques of stereotactic body radiotherapy allow delivery of much higher biologically effective dose to tumor achieving similar outcomes to radical surgery in early stage diseases. However, the usually large tumor volume together with preex‐ iting poor lung condition makes radiotherapy challenging to deliver a radical dose to tumor while maintaining normal tissue constrains. In this chapter, different indications and techniques used in treating NSCLC will be discussed and reviewed.
Radiotherapy in lung cancer: Current and future role
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital
L ung cancer is known to be the most commonly diagnosed cancer with high mortality and morbidity. Lung cancer is divided into two groups as non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These two groups should be seen as two different diseases concerning their clinical course. 80-85% of newly diagnosed lung cancer patients are NSCLC, and 15-20% is SCLC. According to Turkey cancer statistics in 2017, lung cancer is the first in cancer rate in men (52.5/100.000) and the fifth most common type of cancer in women (8.7/100000). 1-The Role of Radiotherapy in Non-Small Cell Lung Cancer Non-small cell lung cancer (NSCLC), which forms the majority of lung cancers, consists of squamous cell cancer, adenocarcinoma and large cell cancers. Although surgical resection is curative in the group without severe concomitant disease at the early-stage, radiosurgery has taken its place as the standard treatment approach in patients with comorbid disease. However, this group covers only 30% of the patients. [1, 2] Radiotherapy can be applied as definitive in the group with local and regional advanced disease with no surgical chance, as neoadjuvant in the group that has the potential to have surgery and can be applied as adjuvant considering some risk factors after surgery. Radiotherapy in metastatic disease is often used for palliative purposes, but radiosurgery may be an option for metastases in oligometastatic disease. 1A-Early Stage (I-II) Stereotactic Body Radiotherapy or Lung Radiosurgery Radiosurgery, which was introduced to our practice by Swedish brain surgeon Lars Leksell in 1950, was first used in the treatment of brain lesions. With the development Lung cancer is divided into two subgroups concerning its natural course and treatment strategies as follows: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In this review, for NSCLC, the role of stereotactic body radiation therapy (SBRT) in early-stage, chemoradiation in the locally advanced stage, post-operative radiotherapy for patients with high risk after surgery and radiotherapy for metastatic disease will be discussed. Also, for SCLC, the role and timing of thoracic irradiation and prophylactic cranial irradiation (PCI) for the limited and extensive stages will be discussed.
Guidelines for the treatment of lung cancer using radiotherapy
Revista da Associacao Medica Brasileira (1992), 2017
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Asia-Pacific Journal of Clinical Oncology, 2013
Aim: Despite advances in radiotherapy delivery, the prognosis of lung cancer remains poor. Higher doses of radiation have been associated with improved outcomes but may result in higher toxicities. Respiratory gated radiotherapy (RGRT) has the potential to reduce pulmonary toxicity but there are significant limitations and pitfalls to its use. The aim of this article is to (i) describe the RGRT technique currently employed at Nepean and Westmead Hospitals; (ii) discuss the practical issues of implementing such a program; (iii) present the results of our RGRT program and (iv) review the potential uncertainties in using this technique and the methods we have used to overcome these. Methods: A retrospective review of all patients who had a 4D-computed tomography (4D-CT) scan was undertaken. Records from treatment planning systems were used to assess the prospective gating program. Results: Between September 2007 and June 2011, 53 patients at Nepean and 26 patients at Westmead Hospital underwent a 4D-CT. Between April and August 2011, 26 patients at Westmead Hospital underwent a prospective 4D-CT scan as treatment verification. Two of the 26 patients (7.7%) were found to have incomplete coverage of the planning target volume. Both patients underwent respiratory re-coaching, alleviating the need for replanning. Conclusion: RGRT may reduce doses to organs at risk with the potential for dose escalation. However its implementation requires significant staff training, treatment time and resources. Treatment verification with image guided radiation therapy are essential for safe delivery.
International Journal of Radiation Oncology Biology Physics, 1989
A Phase I-II study of intraoperative radiotherapy (IORT) for Stage 111 lung cancer was performed in 34 patients during a period of 58 months. Loco-regional treatment included tumor resection if technically feasible, IORT boost of electron beams using moderate single doses (lo-15 Gy) to tumor bearing areas and external photon beam irradiation (46-50 Gy in 5 weeks) using conventional fields. Indications for this study were unresectable hiliar tumors (14,41%), and mediastinal, hiliar and/or chest wall residual disease following resection (20,59%). Thirtyfour procedures, with 40 IORT fields, have been analyzed to describe the relevant technical aspects and the toxicity. IORT was delivered using acrylic transparent cones of different diameters. Surgical approach consisted in a lateral thoracotomy in all patients (21 right side and 13 left side). Tissues included within the IORT field were: tumor or residual tumor tissues (34, lOO%), collapsed lung parenchyma and main bronchus not surgically manipulated (14, 41%), bronchial stump and vascular suture following resection (19, 55%), mediastinal structures (20, 58%), and brachial plexus (1,3%). The bronchial suture was covered with pleural or pericardial flap after IORT in 10 cases (29%). Lie threatening toxicity related to IORT consisted in broncho-pleural fistula (1,3%) and massive hemoptysis (1, 3%). Other reversible toxic events were acute pneumonitis (12, 85%) and esophagitis (10, 50%). Long term asymptomatic lung fibrosis was detected in 11 cases (32%). Median survival time for the entire group has been 12 months. With a median follow-up time of 12 months the freedom from thoracic recurrence rate is 30% (65% in cases with tumor resection). Projected actuarial survival rates at 4 years were 28% for resected group and 7% for unresected cases. This experience supports IORT as a feasible alternative modality to be used in the management of locally advanced lung cancer. Tolerance of thoracic organs to moderate doses of IORT appeared to be adequate and local control is achieved in certain patients. These results deserve further investigation and confirmation trials.