Treating advanced stage lung cancer
Dr. Steven Frank and Dr. Joe Y. Chang discuss a study on how
concurrent chemotherapy and proton therapy improves survival in
patients with advanced lung cancer.
Proton Therapy for Lung and Thoracic Cancer
Lung cancer remains the number one cancer killer among men and women in North America. The five-year survival rate is just 24 percent among those diagnosed with the disease. Physicians at the MD Anderson Proton Therapy Center are world leaders in the research and treatment of lung cancer and pioneers in developing proton therapy for the benefit of lung cancer and thoracic cancer patients including esophageal cancer, thymoma and mesothelioma.
MD Anderson Proton Therapy Center was the first center to treat lung cancer with concurrent proton therapy and chemotherapy and implement intensity-modulated proton therapy in moving thoracic cancers. Our physicians have extensive experience in caring for patients with thoracic cancers and continue to make strides in treating these diseases.
Benefits of lung and thoracic cancer patients treated with proton therapy
Because the lungs are located close to several critical normal structures in the body, it is challenging to deliver an adequate dose of radiation to a cancerous tumor while sparing these nearby normal tissues. That’s where proton therapy has the advantage for many lung cancer and other thoracic cancer patients.
Using proton technology’s advanced image guidance and ability to precisely target tumors in the lungs, our specialists can deliver powerful radiation dosages with optimal accuracy, sparing critical nearby structures, such as the esophagus, lung, heart and spinal cord. This conformality means the physician can treat the tumor with a higher dose of radiation, which allows normal tissue to function better and may result in better local control of the disease, higher survival rates and improved quality of life. This feature is more crucial for patients who have received previous radiation treatments to the chest and developed thoracic recurrence.
Our experts continue to develop ways to help patients fighting lung cancer, such as treating patients with “gated breathing” or breath-holding techniques. This allows for even more precise delivery of radiation right to the tumor.
Delivering targeted, powerful cancer treatment through pencil beam scanning
In addition to gated breathing techniques, the MD Anderson Proton Therapy Center offers lung cancer patients an even more advanced form of treatment called pencil beam scanning proton therapy or intensity-modulated proton therapy.
What are the types of lung and thoracic cancers that benefit from proton therapy?
Localized non-small cell lung cancer, small cell lung cancer, esophageal cancer, thymoma and mesothelioma
What is the course of treatment for lung cancer patients typically like?
Approximately 15 to 20 percent of lung cancer patients have early-stage tumors that can be treated with surgery or radiation treatment. Another 30 to 50 percent of lung cancer patients have locally advanced tumors that require a combined treatment regimen that includes radiation therapy. For metastatic lung cancer, consolidative radiotherapy is indicated if the patient responded well to chemotherapy, targeted therapy and immunotherapy.
For early-stage lung cancer, only one to two weeks of radiotherapy (4 to 10 treatments) are needed. For locally-advanced lung cancer, typically six weeks (30 treatments) of radiotherapy are needed. For consolidative radiotherapy in metastatic cancer, typically one to three weeks (one to 15 treatments) of radiotherapy are needed. For esophageal cancer, less than six weeks (28 treatments) of radiotherapy is needed.
Approximately 15 percent to 20 percent of lung cancer patients have tumors that can be treated with surgery combined with others such as radiation therapy. Another 30 percent to 50 percent of lung cancer patients have locally advanced tumors that require a combined treatment regimen that includes radiation therapy. But because the lungs are located close to several critical normal structures in the body, it is challenging to deliver an adequate dose of radiation to a cancerous tumor while sparing these nearby normal tissues.
That’s where proton therapy has the advantage for many lung cancer patients.
Approximately 15 percent to 20 percent of lung cancer patients have tumors that can be treated with surgery combined with others such as radiation therapy. Another 30 percent to 50 percent of lung cancer patients have locally advanced tumors that require a combined treatment regimen that includes radiation therapy. But because the lungs are located close to several critical normal structures in the body, it is challenging to deliver an adequate dose of radiation to a cancerous tumor while sparing these nearby normal tissues.
That’s where proton therapy has the advantage for many lung cancer patients.
A decade later, survivor remains grateful for proton therapy
During a routine physical exam in June 2010, my doctor expressed concern about a possible heart abnormality. A CT scan showed my heart was fine, but there was a tumor on my lung. After a biopsy, I learned I had lung cancer. I was completely shocked; I’d had no symptoms.
I’ve always been naturally optimistic and was determined to remain positive that everything would turn out for the best.
During that time, my husband worked for the Energy Institute with The University of Texas System in Austin, Texas. After he shared my diagnosis with colleagues they recommended that we go to MD Anderson.
My lung cancer treatment at MD Anderson
My first appointment at MD Anderson was on July 2, 2010. My care team put together my initial treatment plan: chemotherapy, surgery and radiation therapy.
My husband and I rented an apartment near MD Anderson while I underwent treatment, then returned to Austin on the weekends.
On July 24, I started three rounds of chemotherapy. I had a hard time with nausea, which affected my appetite. My care team prescribed medication to help me cope with the nausea and vomiting.
Once I recovered from chemotherapy, imaging revealed that surgery was not possible due to the location of the tumor. That’s when radiation oncologist Dr. Zhongxing Liao recommended proton therapy. Because the lungs are located close to several critical normal structures in the body, Dr. Liao told me that it would be challenging to deliver a high radiation dosage to the tumor while sparing my nearby normal tissues. That’s why proton therapy was recommended for me. I was relieved to find out that I was able to receive proton therapy and would not have surgery.
On Oct. 12, I started 30 proton therapy treatments. With proton therapy’s ability to precisely target the tumor in my lung, Dr. Liao and her team were able to deliver a higher radiation dose while sparing critical nearby structures. This meant there was no radiation exposure to my esophagus, heart or spinal cord.
I’ve been cancer-free for a decade now
My last proton therapy treatment was on Nov. 10, 2010. I still return to MD Anderson each year for checkups, and Dr. Liao performs stress tests to see if I have any damage to my heart from the radiation. Thankfully, I do not. I experienced a decrease in my kidney function as a result of the chemotherapy, but even that has improved over the years. I am thankful not to experience changes in my lung function over the years.
I can't say that my life has changed post-treatment. The only difference is that I am 10 years older now – 83 to be exact, and that is certainly life-changing!
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Concurrent chemotherapy, proton therapy improves survival in patients with advanced lung cancer
Recent studies have shown that for patients with advanced, inoperable stage III lung cancer, concurrent chemotherapy and specialized radiation treatment, proton therapy offers improved survival compared to historical data for the standard of care. In addition, it has been shown that it can significantly reduce the radiation toxicities of heart and lung in thoracic cancers.
“Advanced lung cancer patients with inoperable disease traditionally have been treated with concurrent chemotherapy and conventional photon radiation therapy. However, the therapy can be very difficult for patients due to associated toxicities and because many patients are also dealing with comorbidities,” says Joe Y. Chang, M.D. “But protons enter the body with a low radiation dose and stop at the tumor, matching its shape and volume or depth. They deposit the bulk of their cancer-fighting energy right at the tumor, thereby reducing the dose to cardiopulmonary structures, which impacts the toxicity, functional status, quality of life and even survival for patients.” Read more about this study.
Undergoing proton therapy for thoracic cancer
"I had 15 treatments of proton therapy to treat the cancer that had spread to my throat and lymph nodes."
Stage III lung cancer survivor in remission
"I returned to MD Anderson for scans and routine doctor visits for four years. Then, during a virtual visit with Dr. Lin, I learned I am officially cancer-free after five years."
Why I’m grateful for proton therapy
"My doctors recommended proton therapy because the cancerous lymph node was so close to my heart, and this would limit its exposure to radiation."