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 an 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.[1]
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[1]
- 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:[1]
- 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