Radiation therapy is required for about 20% of all patients with malignant lung tumors because their tumors cannot be operated on (e.g., because of concomitant diseases, poor lung function). Small Cell Lung Cancer (SCLC) (20-25%).
- In small cell lung cancer without distant metastases (tumor cells that have spread and settled by the blood or lymphatic route to organs other than the originally affected organ), simultaneous (parallel) radiochemotherapy (RCTX; combination of radiation therapy (e.g. E.g., with gamma radiation) and chemotherapy (administration of cytostatic drugs)).If this is contraindicated (there is a contraindication), radiochemotherapy (RCTX) should be performed sequentially – radiotherapy (radiotherapy, radiatio) after chemotherapy.
- Radiotherapy consists of thoracic radiotherapy (TRT) followed by prophylactic whole brain irradiation (PCI; prophylactic cranial irradiation) (PCI = standard of care in the limited stage; in the extended stage, PCI is performed on a patient-specific basis).
- Regarding overall survival, the use of prophylactic whole-brain irradiation in the extended stage is controversial.
- An adapted (supportive) supportive therapy during radiotherapy (radiotherapy, radiatio) is always essential.
Further notes
- In stage III small-cell bronchial carcinoma, a higher radiation dose of 60 Gy as part of radiochemotherapy can significantly prolong median overall survival (60 Gy: 41.6 months versus 45 Gy: 22.9 months) without increased radiation toxicity (radiation injury). In this setting, all patients were also offered prophylactic cranial irradiation at doses ranging from 25 Gy in 10 fractions to 30 Gy in 15 fractions.
Non-small cell lung cancer (NSCLC, “non-small-cell lung carcinoma”) (10-15%).
- In stages I-II, percutaneous sterotactic radiotherapy (radiation therapy) is used when surgery is not possible or is refused by the patient. It achieves local tumor control in 92% of cases. The 3-year survival rate is thereby 60%.
- In locally advanced non-small cell lung cancer (LA-NSCLC), chemoradiotherapy (CRT) is usually performed.
- In non-small cell bronchial carcinoma, radiotherapy dominates stage III.
- Increasingly, a multimodality approach is being implemented in which (radio)chemotherapy is used first before the tumor is removed by surgery (neoadjuvant (radio)chemotherapy).
- Whole brain radiotherapy (WBRT) is often used for brain metastases from non-small cell lung cancer (NSCLC). The QUARTZ study showed that omitting WBRT did not result in a loss of life.See below “Further Hints” for prophylactic brain irradiation.
- In stage IV, a combination of radio- and chemotherapy is performed in selected cases.
Further notes
- Prophylactic cranial radiotherapy (PCI; brain irradiation): this is associated with prolonged progression-free survival, according to one study; it is also less likely to result in HIrn metastases. However, the strategy had no effect on overall survival.
- In patients with locally advanced non-small cell lung cancer (NSCLC), pneumonitis (a collective term for any form of lung inflammation (pneumonia) that does not affect the alveoli (air sacs) but rather the interstitium or the intercellular space) of grade ≥ 3 (7.9 vs. 3.5%; p = 0.039); there were no significant differences between methods that for 2-year overall survival, progression-free survival, local treatment failure, and survival without distant metastases.
- Radiotherapy before surgery is recommended for Pancoast tumor (synonym: apical sulcus tumor).It is a rapidly progressive peripheral bronchial carcinoma in the area of the lung apex (apex pulmonis); rapidly spreading to the ribs, soft tissues of the neck, brachial plexus (ventral branches of the spinal nerves of the last four cervical and first thoracic segments (C5-Th1)) and vertebrae of the cervical and thoracic spine (cervical spine, thoracic spine)); disease often manifests with a characteristic pancoast syndrome: shoulder or Arm pain, rib pain, paresthesia (sensory disturbances) in the forearm, paresis (paralysis), hand muscle atrophy, upper influence congestion due to constriction of the jugular veins, Horner’s syndrome (triad associated with miosis (pupil constriction), ptosis (drooping of the upper eyelid) and pseudoenophthalmos (apparently sunken eyeball)).
- Bronchial carcinoma in patients with chronic obstructive pulmonary disease (COPD) is treated with stereotactic ablative radiotherapy (SABR; “ablative radiation”).
- In a study of 58 patients with operable bronchial carcinoma to determine whether radiotherapy with SABR was equivalent or superior to surgery, the following was found:
- In the group of patients who underwent surgery, six of 27 patients died during the first three years, two of whom died of the original bronchial carcinoma and one of whom died of newly developed bronchial carcinoma.
- Among the 31 patients who received stereotactic ablative radiation, there was only one death. In this case, the tumor had continued to grow despite radiotherapy.
- Esophagitis under radiotherapy: less common with age.
