Skip to main content
SpringerLink
Log in

Radiotherapy in Lung Cancer

  • Chapter
  • First Online:
Lung Cancer Imaging

Part of the book series: Contemporary Medical Imaging ((CMI))

  • 2521 Accesses

Abstract

Radiation therapy has evolved into an integral modality in the treatment of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). As technology has evolved, stereotactic body radiotherapy (SBRT) can now be used to achieve excellent local control in patients with early stage NSCLC who are non-operative candidates. Randomized trials are now comparing SBRT to surgery in early stage NSCLC. Chemoradiotherapy (CRT) is used as definitive therapy in the majority of cases of locally advanced NSCLC and can be used as neoadjuvant or adjuvant treatment to surgery in select cases. Most patients with SCLC will receive radiotherapy to the brain to treat brain metastases or prevent brain metastases, and patient with SCLC receive thoracic radiotherapy. In metastatic lung cancer, radiotherapy is used for palliation of brain metastases, spinal cord compression, superior vena cava syndrome, bony pain, hemoptysis, and airway obstruction. As treatment techniques continue to evolve, radiotherapy alone or in combination with new targeted therapies will continue to play an important role in the management of patients with lung cancer while reducing toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tyldesley S, Boyd C, Schulze K, Walker H, Mackilop WJ. Estimating the need for radiotherapy for lung cancer: an evidence-based, epidemiologic approach. Int J Radiat Oncol Biol Phys. 2001;49(4):973–85.

    Article  PubMed  CAS  Google Scholar 

  2. Kong FM, Zhao L, Hayman JA. The role of radiation therapy in thoracic tumors. Hematol Oncol Clin North Am. 2006;20(2):363–400.

    Article  PubMed  Google Scholar 

  3. Decker RH, Tanoue LT, Colasanto JM, Detterbeck FC, Wilson LD. Evaluation and definitive management of medically inoperable early-stage non-small-cell lung cancer. Part 1: assessment and conventional radiotherapy. Oncology (Williston Park). 2006;20(7):727–36.

    Google Scholar 

  4. Zimmermann FB, Bamberg M, Molls M, Jeremic B. Radiation therapy alone in early stage non-small cell lung cancer. Semin Surg Oncol. 2003;21:91–7.

    Article  PubMed  Google Scholar 

  5. Narayan S, Henning GT, Ten Haken RK, Sullivan MA, Martel MK, Hayman JA. Results following treatment to doses of 92.4 or 102.9 Gy on a phase I dose escalation study for non-small cell lung cancer. Lung Cancer. 2004;44(1):79–88.

    Article  PubMed  Google Scholar 

  6. Urbanic JJ, Turrisi AT, Sharma AK, et al. Conformal high dose external radiation therapy, 80.5 Gy, alone for medically inoperable non-small cell lung cancer: a retrospective analysis. J Thorac Oncol. 2006;1(2):112–9.

    Article  PubMed  Google Scholar 

  7. Bradley J, Graham MV, Winter K, et al. Toxicity and outcome results of RTOG 9311: a phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys. 2005;61:318–28.

    Article  PubMed  Google Scholar 

  8. Chang JY, Dong L, Liu H, et al. Image-guided radiation therapy for non-small cell lung cancer. J Thorac Oncol. 2008;3(2):177–86.

    Article  PubMed  Google Scholar 

  9. Heinzerling JH, Anderson JF, Papiez L, et al. Four-dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver. Int J Radiat Oncol Biol Phys. 2008;70(5):1571–8.

    Article  PubMed  Google Scholar 

  10. Timmerman R, Papiez L, McGarry R, et al. Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Chest. 2003;124(5):1946–55.

    Article  PubMed  Google Scholar 

  11. Timmerman R, McGarry R, Tiannoutsos C, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006;24(30):4833–9.

    Article  PubMed  Google Scholar 

  12. Onishi H, Shirato H, Nagata Y, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2007;2(7 Suppl 3):S94–100.

    Article  PubMed  Google Scholar 

  13. Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303:1070–6.

    Article  PubMed  CAS  Google Scholar 

  14. Baumann P, Nyman J, Lax I, et al. Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries. Acta Oncol. 2006;45(7):787–95.

    Article  PubMed  Google Scholar 

  15. Fritz P, Kraus HJ, Muhlnickel W, et al. Stereotactic, single-dose irradiation of stage I non-small cell lung cancer and lung metastases. Radiat Oncol. 2006;1:30.

    Article  PubMed  Google Scholar 

  16. Nyman J, Johansson KA, Hulten U, et al. Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer—mature results for medically inoperable patients. Lung Cancer. 2006;51(1):97–103.

    Article  PubMed  Google Scholar 

  17. Zimmermann FB, Geinitz H, Schill S, et al. Stereotactoc hypofractionated radiation therapy for stage I non-small cell lung cancer. Lung Cancer. 2005;48(1):107–14.

    Article  PubMed  Google Scholar 

  18. Matsuo Y, Shibuya K, Nagata Y, et al. Prognostic factors in stereotactic body radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;79(4):1104–11.

    Article  PubMed  Google Scholar 

  19. Xia T, Li H, Sun Q, et al. Promising clinical outcome of stereotactic body radiotherapy for patients with inoperable stage I/II non-small cell-lung cancer. Int J Radiat Oncol Biol Phys. 2006;66(1):117–25.

    Article  PubMed  Google Scholar 

  20. Hara R, Itami J, Aruga T, et al. Clinical outcomes of single-fraction stereotactic radiation therapy of lung tumors. Cancer. 2006;106(6):1347–52.

    Article  PubMed  Google Scholar 

  21. Onimaru R, Shirato H, Shimizu S, et al. Tolerance of organs at risk in small-volume, hypofractionated, image-guided radiotherapy for primary and metastatic lung cancers. Int J Radiat Oncol Biol Phys. 2003;56(1):126–35.

    Article  PubMed  Google Scholar 

  22. Nagata Y, Takayama K, Matsuo Y, et al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys. 2005;63(5):1427–31.

    Article  PubMed  Google Scholar 

  23. Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol. 2010;28(35):5153–9.

    Article  PubMed  Google Scholar 

  24. Grills IS, Mangona VS, Welsh R, et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol. 2010;28(6):928–35.

    Article  PubMed  Google Scholar 

  25. Rusch VW, Giroux DJ, Kraut MJ, et al. Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Clin Oncol. 2007;25(3):313–8.

    Article  PubMed  Google Scholar 

  26. Turrisi AT, Scott C, Rusch V, et al. Randomized trial of chemoradiotherapy to 61 Gy [no S] versus chemoradiotherapy to 45 Gy followed by surgery [S] using cisplatin etoposide in stage IIIa non-small cell lung cancer (NSCLC): intergroup trial 0139, RTOG (9309). Int J Radiat Oncol Biol Phys. 2003;57:S125–6.

    Article  Google Scholar 

  27. Dillman RO, Seagren SL, Propert KJ, et al. A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med. 1990;323:940–5.

    Article  PubMed  CAS  Google Scholar 

  28. Dillman RO, Herndon J, Seagren SL, et al. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996;88:1210–5.

    Article  PubMed  CAS  Google Scholar 

  29. Sause WT, Scott C, Taylor S, et al. Radiation Therapy Oncology Group (RTOG) 88–08 and Eastern Cooperative Oncology Group (ECOG) 4588: preliminary results of a phase III trial in regionally advanced, unresectable non-small-cell lung cancer. J Natl Cancer Inst. 1995;87:198–205.

    Article  PubMed  CAS  Google Scholar 

  30. Sause W, Kolesar P, Taylor S, et al. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest. 2000;117:358–64.

    Article  PubMed  CAS  Google Scholar 

  31. Curran W, Paulus R, Langer C, et al. Sequential vs concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011;103:1–9.

    Article  Google Scholar 

  32. Fournel P, Robinet G, Thomas P, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d’Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95–01 Study. J Clin Oncol. 2005;23(25):5910–7.

    Article  PubMed  CAS  Google Scholar 

  33. Auperin A, Le Pechoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2181–90.

    Article  PubMed  CAS  Google Scholar 

  34. Bradley J, Moughan J, Graham MV, et al. A phase I/II radiation dose escalation study with concurrent chemotherapy for patients with inoperable stages I to III non-small-cell lung cancer: phase I results of RTOG 0117. Int J Radiat Oncol Biol Phys. 2010;77:367–72.

    Article  PubMed  CAS  Google Scholar 

  35. Machtay M, Hsu C, Komaki R, et al. Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: analysis of the Radiation Therapy Oncology Group (RTOG) experience. Int J Radiat Oncol Biol Phys. 2005;63:667–71.

    Article  PubMed  Google Scholar 

  36. Simon G, Ginsberg RJ, Ruckdeschel JC. Small-cell lung cancer. Chest Surg Clin N Am. 2001;11(1):165–88; ix.

    Google Scholar 

  37. Perry MC, Eaton WL, Propert KJ, et al. Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med. 1987;316(15):912–8.

    Article  PubMed  CAS  Google Scholar 

  38. Pignon JP, Arriagada R, Ihde DC, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med. 1992;327(23):1618–24.

    Article  PubMed  CAS  Google Scholar 

  39. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol. 1992;10(6):890–5.

    PubMed  CAS  Google Scholar 

  40. Murray N, Coy P, Pater JL, et al. Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1993;11(2):336–44.

    PubMed  CAS  Google Scholar 

  41. Takada M, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol. 2002;20(14):3054–60.

    Article  PubMed  CAS  Google Scholar 

  42. Turrisi III AT, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med. 1999;340(4):265–71.

    Article  PubMed  CAS  Google Scholar 

  43. Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007;357(7):664–72.

    Article  PubMed  CAS  Google Scholar 

  44. Jeremic B, Shibamoto Y, Nikolic N, et al. Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: a randomized study. J Clin Oncol. 1999;17:2092–9.

    PubMed  CAS  Google Scholar 

  45. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group. Lancet. 1998;352:257–63.

    Google Scholar 

  46. Bogart JA, Aronowitz JN. Localized non-small cell lung cancer: adjuvant radiotherapy in the era of effective systemic therapy. Clin Cancer Res. 2005;11(13 Pt 2):5004s–10s.

    Article  PubMed  CAS  Google Scholar 

  47. Sawyer TE, Bonner JA, Gould PM, et al. The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement. Cancer. 1997;80:1399–408.

    Article  PubMed  CAS  Google Scholar 

  48. Machtay M, Lee JH, Shrager JB, Kaiser LR, Glatstein E. Risk of death from intercurrent disease is not excessively increased by modern postoperative radiotherapy for high-risk resected non-small-cell lung carcinoma. J Clin Oncol. 2001;9(19):3912–7.

    Google Scholar 

  49. Trodella L, Granone P, Valente S, et al. Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Radiother Oncol. 2002;62(1):11–9.

    Article  PubMed  Google Scholar 

  50. Douillard JY, Rosell R, De Lena M, et al. Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine International Trialist Association (ANITA) Randomized Trial. Int J Radiat Oncol Biol Phys. 2008;72(3):695–701.

    Article  PubMed  CAS  Google Scholar 

  51. Konski AS, Feigenberg S, Chow E. Palliative radiation therapy. Semin Oncol. 2005;32(2):156–64.

    Article  PubMed  Google Scholar 

  52. Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363(9422):1665–72.

    Article  PubMed  Google Scholar 

  53. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500.

    Article  PubMed  CAS  Google Scholar 

  54. Patchell RA, Tibbs PA, Regine WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280(17):1485–9.

    Article  PubMed  CAS  Google Scholar 

  55. Hartsell WF, Scott CB, Bruner DW, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97(11):798–804.

    Article  PubMed  Google Scholar 

  56. Wu JS, Wong R, Johnston M, Bezjak A, Whelan T, Cancer Care Ontario Practice Guidelines Initiative Supportive Care Group. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003;55(3):594–605.

    Article  PubMed  Google Scholar 

  57. Stuschke M, Eberhardt W, Pottgen C, et al. Prophylactic cranial irradiation in locally advanced non-small-cell lung cancer after multimodality treatment: long-term follow-up and investigations of late neuropsychologic effects. J Clin Oncol. 1999;17(9):2700–9.

    PubMed  CAS  Google Scholar 

  58. Andre F, Grunenwald D, Pujol JL, et al. Patterns of relapse of N2 nonsmall-cell lung carcinoma patients treated with preoperative chemotherapy: should prophylactic cranial irradiation be reconsidered? Cancer. 2001;91(12):2394–400.

    Article  PubMed  CAS  Google Scholar 

  59. Gore EM, Bae K, Wong SJ, et al. Phase III comparison of prophylactic cranial irradiation versus observation in patients with locally advanced non-small-cell lung cancer: primary analysis of radiation therapy oncology group study RTOG 0214. J Clin Oncol. 2010;29(3):272–8.

    Article  PubMed  Google Scholar 

  60. Arriagada R, Le Chevalier T, Borie F, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. J Natl Cancer Inst. 1995;87(3):183–90.

    Article  PubMed  CAS  Google Scholar 

  61. Aupérin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 1999;341(7):476–84.

    Article  PubMed  Google Scholar 

  62. Le Péchoux C, Dunant A, Senan S, et al. Stand-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99–01, EORTC 22003–08004, RTOG 0212, and IFCT 99–01): a randomised clinical trial. Lancet Oncol. 2009;10(5):467–74.

    Article  PubMed  Google Scholar 

  63. Singh AK, Lockett MA, Bradley JD. Predictors of radiation-induced esophageal toxicity in patients with non-small-cell lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2003;55(2):337–41.

    Article  PubMed  Google Scholar 

  64. Bradley JD, Hope A, El Naga I, et al. A nomogram to predict radiation pneumonitis, derived from a combined analysis of RTOG 9311 and institutional data. Int J Radiat Oncol Biol Phys. 2007;69(4):985–92.

    Article  PubMed  Google Scholar 

  65. Claude L, Pérol D, Ginestet C, et al. A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis. Radiother Oncol. 2004;71(2):175–81.

    Article  PubMed  Google Scholar 

  66. Schallenkamp JM, Miller RC, Brinkmann DH, et al. Incidence of radiation pneumonitis after thoracic irradiation: dose-volume correlates. Int J Radiat Oncol Biol Phys. 2007;67(2):410–6.

    Article  PubMed  Google Scholar 

  67. Borst GR, De Jaeger K, Belderbos JS, Burgers SA, Lebesque JV. Pulmonary function changes after radiotherapy in non-small-cell lung cancer patients with long-term disease-free survival. Int J Radiat Oncol Biol Phys. 2005;62(3):639–44.

    Article  PubMed  Google Scholar 

  68. Marks LB, Bentzen SM, Deasy JO, et al. Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S70–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC, 26425, USA

    S. Lewis Cooper M.D. & Anand Sharma M.D.

Authors
  1. S. Lewis Cooper M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anand Sharma M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anand Sharma M.D. .

Editor information

Editors and Affiliations

  1. Medical University of South Carolina, Department of Radiology, Ashley Ave. 169, Charleston, 29425, South Carolina, USA

    James G. Ravenel

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Cooper, S.L., Sharma, A. (2013). Radiotherapy in Lung Cancer. In: Ravenel, J. (eds) Lung Cancer Imaging. Contemporary Medical Imaging. Humana Press, New York, NY. https://doi.org/10.1007/978-1-60761-620-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-620-7_12

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-60761-619-1

  • Online ISBN: 978-1-60761-620-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation