Radiotherapy is one of the main means of tumor treatment, and may even cure some tumors. Radiation therapy that can cure tumors and achieve long-term survival is called “radical radiotherapy”; when the tumor cannot be cured, but the symptoms can be relieved and the quality of life can be improved through radiotherapy, it is called “palliative radiotherapy”.
The scope and dose of these two types of radiotherapy are different.
In terms of dose, the dose of radical radiotherapy is generally higher than that of palliative radiotherapy, but this does not mean that the dose should be increased blindly, as the doctor will weigh the radiation damage to normal tissues at the same time, not at the cost of serious sequelae.
From the perspective of irradiation scope, radical radiotherapy should cover not only all visible tumor lesions, but also “latent” lesions that are invisible to clinical examination but may already exist, which is professionally called “subclinical lesions”; whereas palliative radiotherapy only irradiates the areas that cause symptoms, and does not need to cover the “latent” lesions. Palliative radiotherapy only irradiates the symptomatic areas and does not need to cover all lesions, much less subclinical lesions.
The following conditions can be “cured” with radiation therapy
- Patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate or do not want to undergo surgery can receive stereotactic body radiation therapy (SBRT) for radical treatment.
- Patients with locally advanced NSCLC may be considered for combined radiotherapy and chemotherapy.
- Patients with “oligometastases” can be treated with local radical radiotherapy (including stereotactic radiotherapy) if their disease is controlled with systemic therapy.
- Patients with limited-stage small cell lung cancer (SCLC) treated with concurrent radiotherapy.
- Advanced lung cancer with widespread metastases that cause corresponding symptoms due to tumor invasion or compression (e.g. bone metastases causing pain; brain metastases causing brain tissue compression symptoms; lung lesions causing cough and shortness of breath, etc.), and palliative radiotherapy targeting the metastases causing symptoms.
- Patients with advanced disease presenting with oligometastatic progression after systemic therapy (including systemic chemotherapy, targeted therapy, immunotherapy) can have palliative radiotherapy for these lesions.
- Some patients with locally advanced NSCLC and limited-stage SCLC can be converted to palliative radiotherapy because the lesions are too extensive to achieve the dose of radical radiotherapy.
- Patients with extensive stage SCLC can prolong survival with palliative radiotherapy to the lung lesions after effective systemic chemotherapy.
- “Oligometastases” refers to the presence of distant metastases (advanced), but the number of metastases is relatively small (usually less than 5), and with systemic therapy to control the tumor, supplemented by aggressive local therapy (such as surgery or radical radiotherapy), some patients can achieve long-term survival and possibly cure.
In the following cases, radiotherapy is not curative but can relieve symptoms and improve quality of life
It is important to note that both radical and palliative radiotherapy can have a therapeutic effect, and not “give up treatment” as some people understand it. Your doctor will choose a specific plan based on your actual situation.
Co-reviewed by: Dr. Chen Zhiyong, Chief Physician, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute