Treatment: Radiation Therapy
Radiation therapy (RT) is an integral part of treating all stages of lung cancer. Stereotactic ablative radiation therapy (SABR) has emerged as a standard treatment option for stage I–II patients with medically inoperable disease. Stage IIIA–IIIB disease
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Abstract
Radiation therapy (RT) is an integral part of treating all stages of lung cancer. Stereotactic ablative radiation therapy (SABR) has emerged as a standard treatment option for stage I–II patients with medically inoperable disease. Stage IIIA–IIIB disease is typically managed with definitive concurrent chemo-radiotherapy (CRT). Intensity modulated radiation therapy (IMRT) has enabled delivery of more potent RT dose while greatly limiting dose to surrounding normal organs, including lung, esophagus, and heart. SABR may have an expanding role in the treatment of stage IV patients, with new clinical trials exploring its combination with systemic immuotherapies. Keywords
Radiation Lung cancer Chemoradiation
SABR
Stereotactic
Oligometastases
Contents 1 Stage I–II Disease................................................................................................................ 1.1 Conventional Radiation Therapy................................................................................ 1.2 Stereotactic Ablative Radiation Therapy ................................................................... 1.3 Toxicities ....................................................................................................................
106 106 106 108
2 Stage III Disease.................................................................................................................. 108 2.1 Technological Advancements..................................................................................... 108 3 Clinical Results.................................................................................................................... 109 3.1 Radiation Alone.......................................................................................................... 109
S. Sampath (&) Department of Radiation Oncology, City of Hope Medical Center Duarte, Duarte, CA, USA e-mail: [email protected] © Springer International Publishing Switzerland 2016 K.L. Reckamp (ed.), Lung Cancer, Cancer Treatment and Research 170, DOI 10.1007/978-3-319-40389-2_5
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S. Sampath 3.2 3.3 3.4 3.5 3.6
Sequential Chemotherapy Followed by Radiation .................................................... Sequential Versus Concurrent Chemotherapy and Radiation Therapy ..................... Radiation Dose Escalation with Concurrent Chemotherapy ..................................... Induction Chemotherapy Prior to Definitive Chemoradiation................................... Role of Consolidation Chemotherapy Following Concurrent Chemoradiation ........
109 110 111 112 112
4 Stage IV Patients and Oligometastases ............................................................................... 4.1 Synchronous Brain Metastases................................................................................... 4.2 SABR in Stage IV Disease ........................................................................................ 4.3 Future Directions .............................................................................
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