Lung Cancer Radiation Therapy

  Early stage non-small cell lung cancer: radical surgical resection is the fundamental treatment for this disease. Postoperative chemotherapy is not recommended for stage I. Postoperative chemotherapy is recommended for stage II.  If the patient has a medical condition that prevents surgery or refuses surgery, radiotherapy is an alternative radical treatment.  For patients with locally advanced lung cancer, postoperative radiotherapy can significantly improve regional tumor control, but not survival. As the precision of radiotherapy has improved significantly, the dose of radiotherapy to the tumor area has been increased while the dose to the normal tissues and organs surrounding the tumor has been decreased.  Radiation therapy for advanced lung cancer: 1. Brain metastasis is a more common distant metastasis of lung cancer, and the incidence of brain metastasis in NSCLC patients is about 25%. About 1/3-1/2 of lung cancer patients die directly from brain metastases [2]. Whole brain irradiation is used for multiple brain metastases, and the lower edge of the radiation field is usually at the skull base line, but the lower edge of the pterygoid sinus should be included to fully include the brain tissue in the middle cranial fossa. The whole brain is irradiated with 40 Gy/16 times for 3.2 weeks, with an additional 10 Gy/4 times for 0.8 weeks for local tumors; or 30 Gy/10 times for 2 weeks for the whole brain, with an additional 15 Gy/5 times for 1 week for local tumors. Whole brain irradiation of 30Gy/10 times for 2 weeks should also be given after surgical resection of single metastases. Stereotactic radiotherapy, such as γ-knife and X-knife, is indicated for the treatment of lung cancer brain metastases with isolated brain metastases, but should be performed on the basis of whole brain irradiation.  Bone metastases About 20%-40% of lung cancer patients have bone metastases with clinical symptoms. The most common sites of bone metastases are: vertebrae, pelvis, femur-iliac bone. Most lung cancer bone metastases are osteolytic type, and osteogenic type is rare. Radiotherapy is the main palliative treatment for bone metastases, aiming at relieving pain, preventing pathological fractures or further complications caused by bone destruction, and maintaining the patient’s mobility. The overall remission rate of lung cancer bone metastases with radiotherapy is 51%, and the complete remission rate is 46%. The commonly used methods are 30Gy/10 times, 25Gy/5 times and 8-10Gy/1 time.  3.Superior vena cava compression syndrome (SVCS) occurs in less than 5% of lung cancer patients. The main symptoms include obvious shortness of breath, even seated breathing, severe edema of the head, neck, both upper limbs and chest wall, and angry veins in the chest and abdominal wall. SVCS can be life-threatening, produce intracranial hypertension, or produce airway obstruction. Therefore, SVCS should be treated as an emergency. For SVCS in NSCLC, if distant metastasis has not yet occurred, more aggressive radiotherapy is recommended, starting with a larger fractionated dose of 3Gy-4Gy/dose, starting with 4-5 irradiations, and then changing to conventional fractionated irradiation to 60Gy-65Gy. The radiation field should include all clinical tumors as much as possible, including the ipsilateral hilum and mediastinal drainage area if possible. Chemotherapy can also be used in combination with radiotherapy.