4 advances in radiation therapy for lung cancer treatment

One of the most difficult aspects of treating lung cancer with radiation therapy is determining the best way to deliver it. Ideally, doctors want to provide the most effective dose to a tumor while limiting exposure to healthy adjacent organs, tissues and structures.

The challenge with lungs is that they’re always in motion. This can make it difficult to keep radiation focused directly on tumors.

“Right now, we have to ask patients to hold their breath during treatment to minimize movement,” says radiation oncologist Zhongxing Liao, M.D.

That can make it tricky to protect critical organs, such as the heart, liver — and even unaffected sections of the lungs.

Fortunately, all of that is changing. Here’s how.

Next-generation technologies include real-time motion management

Next-generation technologies are enabling physicians to shield healthy tissues more effectively. By using machines that can scan patients during their treatment sessions, radiation oncologists are able to make real-time adjustments to accommodate patients’ movements.

“The technology of radiation therapy is evolving every day,” says Liao. “We went from simple X-ray films in the early 1990s to cutting-edge, on-board imaging in the 2010s. Now, we’re building our second-generation proton therapy machine, which will use respiratory motion management and real-time tracking to monitor each patient’s position.”

Combination cancer treatments becoming standard of care

Other recent advances in radiation therapy for lung cancer include stereotactic ablative radiation therapy (SABR) and stereotactic body radiation therapy (SBRT). Both deliver super-high-dose radiation to small targets in a very short period of time — usually four to 10 treatments within one to two weeks.

“That makes them very effective at killing cancer cells,” Liao says. “It also makes them comparable to surgery in terms of their ability to successfully eliminate some cancers.”

Proton therapy can be a good option for many patients, too, because of its unique depth-dose characteristics. And combining radiation therapy with other treatments (such as chemotherapy, immunotherapy, and targeted therapy) has proven so effective that chemotherapy plus radiation therapy and immunotherapy is now considered the standard of care for patients with locally advanced lung cancers.

“Proton therapy is especially useful when tumors are located next to the heart,” adds Liao. “It’s also good at treating solid tumors, because those have enough mass to prevent its radiation from passing through them.”

Options for both treating lung cancer and limiting its progression

Radiation therapy is often used in early-stage lung cancer patients who cannot — or choose not to — have surgery. But radiation therapy can also limit disease progression in patients with more advanced lung cancers.

“MD Anderson has some of the most advanced radiation technology available,” Liao says. “So, we have treatment options for patients in every stage of lung cancer.”

Protecting patients from unnecessary radiation exposure

To prevent damage to healthy structures from excess radiation exposure during lung cancer treatment, MD Anderson has established dose constraints for every organ located in or near the chest cavity, such as the heart, liver and esophagus.

“We set our bar very high to make sure critical organs are well-protected,” says Liao. “Every tumor is unique, so we evaluate each treatment plan before therapy starts to determine which radiation therapy technology best fits the needs of the patient.”

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