Squamous cell carcinoma of the lung radiation therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2] Maria Fernanda Villarreal, M.D. [3]

Overview

Radiation therapy is recommended as palliative care among patients who develop advanced stage of squamous cell carcinoma of the lung or symptomatic patients with local involvement (pain, vocal cord paralysis, and hemoptysis). Curative radiation therapy may be indicated in patients who are not suitable for surgery with early stage squamous cell carcinoma of the lung. The main goal of radiation therapy for squamous cell carcinoma of the lung is maximum tumor control with minimal tissue toxicity. There are 2 main types of radiation therapy for squamous cell carcinoma of the lung: external beam radiation therapy and brachytherapy (internal radiation therapy).

Radiation Therapy

• Radiation therapy for squamous cell carcinoma of the lung, includes:

• Curative intent radiation therapy
• Palliative radiation therapy

• Indications for radiation therapy in squamous cell carcinoma of the lung, include:

• Sufficient pulmonary reserve
• Stage I
• Stage II without fitness for surgery
• Stage IIIA or IIIB squamous cell carcinoma of the lung and are not fit for chemoradiation

• Common types of external beam radiation therapy for the treatment of squamous cell carcinoma of the lung, include:

• Three-dimensional conformal radiation therapy
• Intensity modulated radiation therapy
• Stereotactic body radiation therapy
• Stereotactic radiosurgery

Radiation Therapy Regimens

Shown below is a list of the different regimens radiation therapy for patients with non-small cell lung cancer. The list of regimens has been adapted from the 2014 NCCN Non-small cell lung cancer guidelines.

Usual Dosages for Definitive Radiation Therapy

Administer fractions of 2 Gy over a period of 6 to 7.5 weeks to a total dose of 60 to 74 Gy

Neoadjuvant Radiation Therapy Regimen

Administer fractions of 1.8 to 2 Gy over a period of 5 weeks to a total dose of 45 to 50 Gy

Adjuvant Radiation Therapy Regimens

• Negative surgical piece margins: Administer fractions of 1.8 to 2 Gy over a period of 5 to 6 weeks to a total dose of 40 to 54 Gy
• Positive surgical piece margins: Administer fractions of 1.8 to 2 Gy over a period of 6 weeks to a total dose of 54 to 60 Gy
• Extracapsular nodal extension: Administer fractions of 1.8 to 2 Gy over a period of 6 weeks to a total dose of 60 to 70 Gy
• Residual tumor: Administer fractions of 2 Gy over a period of 6 to 7 weeks to a total dose of 54 to 60 Gy

Stereotactic Ablative Radiotherapy Usual Dosage

• Peripheral small tumors: 25 to 34 Gy not fractioned.
• Peripheral tumors and chest wall tumors larger than 1 cm: 45 to 60 Gy administered in 3 fractions
• Central or peripheral tumors smaller than 5 cm: 48 to 60 Gy administered in 4 fractions
• Central or peripheral tumors principally chest wall tumors smaller that 1 cm: 50 to 55 Gy administered in 5 fractions
• Central tumors: 60 to 70 Gy administered in 8 to 10 fractions

References

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