Non small cell lung cancer radiation therapy

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

Overview

Radiation therapy can be applied to any stage of non-small cell lung cancer. In general, radiation therapy is recommended as palliative care treatment among patients who develop advanced stage of non-small cell lung cancer 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 non-small cell lung cancer. The main goal of radiation therapy for non-small cell lung cancer is maximum tumor control with minimal tissue toxicity. There are 2 main types of radiation therapy for non-small cell lung cancer: external beam radiation therapy (thoracic radiotherapy), and brachytherapy (internal radiation therapy).

Radiation Therapy

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

Palliative Radiation Therapy Regimens

Listed bellow are the recommended palliative radiation therapy regimens for patients with non-small cell lung cancer according to the 2014 NCCN Non-Small Cell Lung Cancer guidelines

• Obstructive disease

• Administer fractions of 3 Gy over a period of 2 to 3 weeks to a total dose of 30 to 45 Gy

• Bone metastases associated with soft tissue mass

• Administer fractions of 4 to 3 Gy over a period of 1 to 2 weeks to a total dose of 20 to 30 Gy

• Bone metastases not associated with soft tissue mass

• Administer fractions of 8 to 3 Gy over a period of 1 to 14 days to a total dose of 8 to 30 Gy

• Patients with poor performance status and symptomatic chest disease

• Administer fractions of 8.5 Gy over a period of 7 to 14 days to a total dose of 17 Gy

• Metastatic disease in patients who have a poor performance status:

• Administer fractions of 8 to 4 Gy over a period of 1 to 7 days to a total dose of 8 to 20 Gy

• Whole brain radiation therapy regimens for metastases to the brain, include the following:

• 10 fractions of 3 Gy each to a total of 30 Gy
• 15 fractions of 2.5 Gy each to a total of 37.5 Gy
• 5 fractions of 4 Gy each to a total of 20 Gy. Good option for patients with poor performance status

References

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