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Curative Radiation Treatment of lung cancer

General

Non-small cell lung cancer

Patients unfit for surgery, or not willing to undergo a surgical procedure, will be offered curatively intended radiation therapy. In stage I, this will be given as stereotactic radiation, with a high radiation dose in few fractions. In stage II or III, fractionated therapy given over several weeks is offered, either alone or in combination with chemotherapy.

Many patients with clinically localized cancer (stage III) have subclinical micrometastases and this group of patients is given systemic chemotherapy simultaneously with curative radiation therapy.

Combinations

  • Induction chemotherapy of 2-3 courses before radiation treatment 
  • Chemotherapy given in parallel with curative radiation therapy as a radiation sensitizer (concomitant treatment)
  • A combination of the above alternatives
  • Adjuvant chemotherapy after concluded curative radiation therapy

There is no evidence for a benefit from routinely postoperative radiation therapy.

Each additional treatment of curative radiation doses causes increased side effects. Internationally, concomitant chemoradiation treatment is recommended. Patients who are not suitable for inclusion of a protocol study, but who still meet the prognostic factors which indicate a curative treatment arrangement, are given radiation alone in doses of 60–74 Gy. 

Stereotactic radiation is first-line treatment of choice for medically inoperable stage I patients.

Small cell lung cancer

Radiation therapy given in addition to chemotherapy provides a survival benefit. Radiation should commence early in the treatment course. 

Indications

Non-small cell lung cancer

  • Stage I and II with good prognostic factors and considered surgically inoperable, or surgery not wanted.  
  • Stage IIIA with good prognostic factors and considered inoperable or inappropriate for neoadjuvant chemotherapy.
  • For stage IIIB, curative radiation treatment is possible if the patient has good prognostic factors.

Small cell lung cancer

  • Localized cancer, stage I–III 

Goal

  • Cure the disease

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