Lung Cancer & Radiation Therapy
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1 Lung Cancer & Radiation Therapy Louis Lao Radiation Oncologist MB ChB, FRANZCR
2 Outline Lung ca prevalence Typical symptoms for lung ca Ix for pt with suspected lung ca How to refer a pt with suspected lung ca Staging of lung ca Treatment of lung ca RT for lung ca
3 Lung cancer prevalence in NZ Cancer deaths accounts for approx 1/3 of deaths each yr Lung ca is the 5 th most common cancer in NZ Lung ca is the most common cause of death for both men and women (18.9% of all cancer deaths) Cancer Registry NZ 2011
4 Lung cancer prevalence in NZ Male Female Registration Deaths Cancer Registry NZ 2011
5
6
7 Symptoms of lung ca Cough (50-75%) Haemoptysis (25-50%) SOB (25%) Chest pain (20%) Weight loss
8 Work up for pt with lung ca Imaging: CXR CT Chest/abdo PET-CT +/- CNS imaging, bone scan, MRI spine Histological confirmation(molecular profiling): CT guided bx Bronchoscopy/EBUS Lung fx
9 How to refer Local DHB lung clinic Pvt respiratory physician Lung Radiation Oncologist/ Lung Medical Oncologist/ Cardiothoracic surgeon
10 Staging for lung ca SCLC limited vs extensive stage NSCLC (majority) TNM T : size, proximity to central structures, satellite N: hilar vs mediastinal LN, ipsilateral vs contra M: distant metastasis NSCLC staging (stage I IV) I /II : localised (highly curable) III: advanced local/regional (potentially curable) IV : metastatic (not curable)
11 Treatment of Lung ca Surgery/RT/Drug treatment (chemo/target Rx) Stage I-II: Surgery SABR Stage II- III: ChemoRT Surgery +/- chemo +/- RT Stage IV: Drug Rx (depending on histo/mutation status) Palliative RT
12 Changing outcome of lung ca Rx Staging PET Surgery minimally invasive/ better selection Med Onc molecular profiling of tumour -> target therapy -> prolong survival in stage IV pts Rad Onc Early stage : SABR Locally advanced : IMRT Stage IV : palliative RT
13 Radiation Therapy for Lung ca
14 Effective palliation for lung ca Haemoptysis Airway compression/lung collapse SVC obstruction Dysphagia Chestwall pain Cough Bone pain Neuropathic pain/nerve compression Brain metastases
15 Locally advanced lung ca Use of modern technology such as IMRT/motion management/igrt allows ability to target tumour more accurately, reduce treatment related toxicity and ability to treat very large tumours
16 Advance technology at ARO 4DCT Symmetry (4D cone beam CT) ABC (active breath control)
17 4D CT
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20 Breath-hold gating Immobilizes anatomy High precision, consistent lung volume Reduces dose to normal tissue & further supports margin reduction strategies
21 SABR in early stage NSCLC
22 Stereotactic Ablative RT Conventional RT SABR Courtesy of Elekta Inc.
23 Before SABR Surgery is the gold standard (LC 80-90%) Many pts are medically inoperable (~20-30%) Options for inoperable pts are either conventional RT or best supportive care Inferior outcome without surgery LC with conventional RT ~ 30-40% LC with no active Rx 0%
24 Local control ~90% Nagata et al IJROBP 2011
25 Treatment outcome comparison Surgery (Gold standard) ~ 90% Conventional RT ~ 30-40% Best supportive care ~ 0% SABR ~ 90%
26 Advantages of SABR Non invasive No hospital stay Short treatment course Minimal interruption to systemic Rx Well tolerated/acceptable SE profile
27 Case 3 mths post SABR 6 mths post SABR Pre SABR
28
29 Thank You
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