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8 - Radiotherapy in Lung Cancer

Published online by Cambridge University Press:  12 August 2009

Shahreen Ahmad
Affiliation:
Department of Clinical Oncology, St Thomas’ Hospital, London, UK
Sujal R. Desai
Affiliation:
King's College Hospital, London
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Summary

Introduction

Lung cancer is the second most common malignancy diagnosed in men after prostate cancer and third most common after breast and colorectal in women. In 2000, there were 38,410 new cases of lung cancer diagnosed in the UK. Incidence increases with age, with the most prevalent age group being the over 75s. As indicated in the chapter on chemotherapy for non-small cell lung cancer (NSCLC), survival rates remain low for patients treated with chemotherapy alone. Radiotherapy is an alternative modality of treatment which offers improved survival advantage to those with locally advanced disease.

Small cell lung cancer is a chemosensitive tumour. Nevertheless, studies have shown that radiotherapy can improve local control in patients who achieve a complete response following chemotherapy and who have disease localized to the chest. There are also data that suggest that some of these patients benefit from prophylactic cranial irradiation, in the absence of proven brain metastases.

A further important role for radiotherapy in lung cancer patients is to treat symptomatic metastatic disease. This is usually in the palliative setting and the location of the metastatic deposit has a bearing on whether radiotherapy is suitable or not. However, radiation therapy can be an extremely effective treatment for symptoms such as pain, haemoptysis and cough. There are certain situations where emergency or urgent radiotherapy is the treatment of choice (e.g. spinal cord compression). Patients are treated in a multidisciplinary setting to ensure optimum management of each individual case.

Type
Chapter
Information
Lung Cancer , pp. 120 - 135
Publisher: Cambridge University Press
Print publication year: 2006

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References

Brennan, P., Bray, I. (2002). Recent trends and future directions for lung cancer mortality in Europe. BJC, 87, 43–8.CrossRefGoogle Scholar
Gregor, A., Cull, A., Stephens, R. J., et al. (1997). Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: results of a multicentre randomised trial. United Kingdom Coordinating Committee for Cancer Research (UKCCCR) and the European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer, 33, 1752–8.CrossRefGoogle Scholar
Auperin, A., Arriagada, R., Pignon, J. P., et al. (1999). Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med, 341, 476–844.CrossRefGoogle ScholarPubMed
Devereux, S., et al. (1997). Immediate side effects of large fraction radiotherapy. Clin Oncol, 9, 96–9.CrossRefGoogle ScholarPubMed
Rees, G. J., Devrell, C. E., Barley, V. L., et al. (1997). Palliative radiotherapy for lung cancer: two versus five fractions. Clin Oncol (R Coll Radiol), 9(2), 90–5.CrossRefGoogle ScholarPubMed
Dillman, R. O., Hendon, J., Seagren, S. L., et al. (1996). Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst, 88(17), 1210–5.CrossRefGoogle Scholar
Sause, W. T., et al. (1995). Radiation Therapy Oncology Group 88–08 and Eastern Cooperative Oncology Group (ECOG) 4588: preliminary results of a phase III trial in regionally advanced unresectable non-small cell lung cancer. J Natl Cancer Inst, 87, 198–205.CrossRefGoogle ScholarPubMed
Furuse, K., Fukuoka, M., Kawahara, M., et al. (1999). Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol, 17(9), 2692–9.CrossRefGoogle ScholarPubMed
Belani, C. P., Choy, H., Bonomi, P., et al. (2005). Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol, 23(25), 5883–91. Epub 2005 Aug 8. Erratum in: J Clin Oncol. 2006 Apr 20; 24(12): 1966.CrossRefGoogle ScholarPubMed
Komaki, R., Seiferheld, W., Ettinger, D., et al. (2002). Randomised Phase II chemotherapy and radiotherapy trial for patients with locally advanced inoperable non-small cell lung cancer: long-term follow-up of RTOG 92–04. Int J Radiation Oncology Biol Phys, 53(3), 548–57.CrossRefGoogle Scholar
PORT Meta-analysis Trialists Group (1998). Post-operative radiotherapy in non-small cell lung cancer: a systematic review of individual patient data from nine randomised trials. Lancet, 352, 257–63.CrossRef
PORT Meta-analysis Trialists Group. (2003). Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev, (1), CD002142. Review.CrossRef
Zhang, H. X., Yin, W. B., Zhang, L. J., et al. (1989). Curative radiotherapy of early operable non-small cell lung cancer. Radiotherapy Oncol, 14, 89–94.CrossRefGoogle ScholarPubMed
Sibley, G. S., Jamieson, T. A., Marks, L. B., et al. (1998). Radiotherapy alone for medically inoperable Stage I non-small cell lung cancer: The Duke experience. Int J Radiation Oncology Biol Phys, 40, 149–54.CrossRefGoogle Scholar
Singh, A., Lockett, M., Bradley, J., et al. (2003). Predictors radiation-induced esophageal toxicity in patients with non-small cell lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiation Oncology Biol Phys, 55, 337–41.CrossRefGoogle ScholarPubMed
Bradley, J., Thorstad, W. L., Mutic, S., et al. (2004). Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. Int J Radiation Oncology Biol Phys, 59(1), 78–86.CrossRefGoogle ScholarPubMed
Withers, H. R., Taylor, J. M. G., Maciejewski, B. (1998). The hazard of accelerated tumour clonogen repopulation during radiotherapy. Acta Oncol, 27, 131–46.CrossRefGoogle Scholar
Baumann, M., Liertz, C., Barisch, H., et al. (1994). Impact of overall treatment time of fractionated irradiation on local control of human FaDu squamous cell carcinoma in nude mice. Radiother Oncol, 32, 137–43.CrossRefGoogle ScholarPubMed
Saunders, M. I., Dische, S., Barrett, A., et al. (1996). Randomised multicentre trials of Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in head and neck cancer and non-small cell lung cancer: an interim report. Brit J Cancer, 73, 1455–62.CrossRefGoogle Scholar
Saunders, M. I., Dische, S., Barrett, A., et al. (1999). Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. Radiother Oncol, 52, 137–47.CrossRefGoogle ScholarPubMed
Gebitekin, C., Gupta, N. K., Satur, C. M., et al. (1994). Fate of patients with residual tumour at the bronchial resection margin. Eur J Cardiothorac Surg, 8(7), 339–42; discussion 342–4.CrossRefGoogle ScholarPubMed
Massard, G., Doddoli, C., Gasser, B., et al. (2000). Prognostic implications of a positive bronchial resection margin. Eur J Cardiothorac Surg, 17(5), 557–65.CrossRefGoogle ScholarPubMed
Pignon, J. P., Arriagada, R., Ihde, D. C., et al. (1992). A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med, 327, 1618–24.CrossRefGoogle ScholarPubMed
Warde, P., Payne, D. (1992). Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung?A meta-analysis J Clin Oncol, 10, 890–95.CrossRefGoogle ScholarPubMed
Coy, P., Hodson, I., Payne, D. G., et al. (1988). The effect of dose of thoracic irradiation on recurrence in patients with limited stage small cell lung cancer. Initial results of a Canadian Multicenter Randomized Trial. Int J Radiat Oncol Biol Phys, 14(2), 219–26.CrossRefGoogle ScholarPubMed
Gregor, A., Drings, P., Burghouts, J., et al. (1997). Randomized trial of alternating versus sequential radiotherapy/chemotherapy in limited-disease patients with small-cell lung cancer: a European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group Study. J Clin Oncol, 15(8), 2840–9.CrossRefGoogle ScholarPubMed
Turrisi, A., Kim, K., Blum, R., et al. (1999). Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med, 340(4), 265–71.CrossRefGoogle ScholarPubMed
Fried, D. B., Morris, D. E., Poole, C., et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited stage small cell lung cancer. J Clin Oncol, 22(23), 4837–45.CrossRef
Healey, E. A., Abner, A. (1995). Thoracic and cranial radiotherapy for limited-stage small cell lung cancer. Chest, 107(6 Suppl), 2595–2545.CrossRefGoogle ScholarPubMed
Jeremic, B., Shibamato, Y., Nikolic, N., et al. (1999). Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study. J Clin Oncol, 17(7), 2092–9.CrossRefGoogle ScholarPubMed
Landberg, T., Charaudra, J., Dobbs, H. J., et al. (1993). Prescribing, recording and reporting photon beam therapy. Bethesda, Maryland: ICRU. International Commission on Radiation Units and Measurements ICRU Report 50.
Landberg, T., Charaudra, J., Dobbs, H. J., et al. (1999). International Commission on Radiation Units and Measurements ICRU Report 62, Supplement to ICRU Report 50.
Grills, I. S., Yan, D., Martinez, A. A., et al. (2003). Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation and elective nodal irradiation. Int J Radiat Oncol Biol Phys, 57(3), 875–90.CrossRefGoogle Scholar
Murshed, H., Lin, H., Zhongxing, L., et al. (2004) Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small cell lung cancer. Int J Radiation Oncology Biol Phys, 58, 1258–67.CrossRefGoogle ScholarPubMed
Armstrong, J. G. (1998). Target volume definition for three-dimensional conformal radiation therapy of lung cancer. British Journal of Radiology, 587–94.CrossRefGoogle ScholarPubMed
Senan, S., Sornsen de Koste, J., Samon, M., et al. (1999). Evaluation of a target contouring protocol for 3D conformal radiotherapy in non-small cell lung cancer. Radiother Oncol, 53, 247–55.CrossRefGoogle ScholarPubMed
Kudo, H. D., Hill, B. C. (1996). Respiration gated radiotherapy treatment: A technical study. Phys Med Biol, 41, 83–91.Google Scholar
Vedam, S. S., Keall, P. J., Kini, V. R., et al. (2001). Determining parameters for respiration-gated radiotherapy. Med Phys, 28, 2139–46.CrossRefGoogle ScholarPubMed
Wong, J. W., Sharpe, M. B., Jaffray, D. A., et al. (1999). The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiation Oncology Biol Phys, 44(4), 911–9.CrossRefGoogle ScholarPubMed
Cheung, P. C., Sixel, K. E., Tirona, R., et al. (2003). Reproducibility of lung tumour position and reduction of lung mass within the planning target volume using active breathing control (ABC). Int J Radiation Oncology Biol Phys, 57(5), 1437–42.CrossRefGoogle Scholar
Low, D. A., Nystrom, M., Kalinin, E., et al. (2003). A method for the reconstruction of four dimensional synchronised CT scans acquired during free breathing. Med Phys, 30(6), 1254–63.CrossRefGoogle Scholar
Vedam, S. S., Keall, P. J., Kini, V. R., et al. (2003). Acquiring a four dimensional computed tomography dataset using an external respiratory signal. Phys Med Biol, 48, 45–62.CrossRefGoogle ScholarPubMed
Keall, P. J., Joshi, S., Vedam, S. S., et al. (2005) Four-dimensional radiotherapy planning for DMLC-based respiratory motion tracking. Med Phys, 32(4), 942–51.CrossRefGoogle ScholarPubMed
Medical Research Council Lung Cancer Working Party. (1991). Inoperable non-small cell lung cancer: A Medical Research Council randomised trial of palliative radiotherapy of two fractions or ten fractions. Br J Cancer, 63, 265–70.CrossRef
Medical Research Council Lung Cancer Working Party (1992). A Medical Research Council randomised trial of palliative radiotherapy of two fractions or a single fraction in patients with inoperable non-small cell lung cancer (NSCLC) and poor performance status. Br J Cancer, 65, 934–41.CrossRef
Macbeth, F. R., et al. (1996). Randomised trial of palliative two-fraction versus more intensive 13-fractionradiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party. Clin Oncol, 8, 167–75.CrossRefGoogle Scholar
Erridge, S. C., Gaze, M. N., Price, A., et al. (2005). Symptom control and Quality of Life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol, 17(1), 61–7.CrossRefGoogle ScholarPubMed
Toy, E., Macbeth, F. R., Cohen, B., et al. (2003). Palliative thoracic radiotherapy for non-small cell lung cancer: a systematic review. Am J Clin Oncol, 26(2), 112–20.CrossRefGoogle ScholarPubMed
Ekberg, L., Holmberg, O., Wittgren, et al. (1998). What margins should be added to the clinical target volume in radiotherapy treatment planning for lung cancer. Radiother Oncol, 48(1), 71–7.CrossRefGoogle ScholarPubMed
Stevens, C., Munden, R., Forster, K., et al. (2001). Respiratory-driven lung tumour motion is independent of tumour size, tumour location and pulmonary function. Int J Radiation Oncology Biol Phys, 51, 62–8.CrossRefGoogle ScholarPubMed
Steel, G. (1997). Basic Clinical radiobiology (2nd Edition).Google Scholar
Vita, V., Hellman, S., Rosenberg, S. (2001). Cancer Principles < Practice of Oncology (6th Edition).Google Scholar

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