Re-Treating Lung Cancer with Radiotherapy Is Effective

An old concept of re-treating lung tumors with radiation is now being reevaluated, particularly with the latest technologic developments experienced in radiation oncology over the last10 years.

The Comprehensive Cancer Center of Wake Forest Baptist Medical Center (Winston-Salem, NC, USA) is one of only several cancer centers in the United States that is attempting to give lung cancer patients out of treatment alternatives to keep the cancer from reappearing. For these patients, hope lies in a second course of treatment--repeat radiation. Two complementary articles published in the March 2014 issue of the journal Radiotherapy and Oncology and the April 2014 issue of the Journal of Thoracic Oncology described the treatment success at Wake Forest Baptist.

“One of the toughest challenges of lung cancer is what to do for patients when the cancer comes back in an area that’s been treated previously with radiation treatment,” said James J. Urbanic, MD, lead author of the studies and a radiation oncologist at Wake Forest Baptist. “With some of the technological advances in radiation treatments that have occurred in the last 5 to 10 years, we’re beginning to re-look at the issue and ask—can we target the radiation precisely enough and with a high enough dose to knock the cancer back?”

According to Dr. Urbanic, the overall findings of the study suggest that there are some patients with recurrent lung tumors who can be treated with another definitive course of radiation therapy and still have a probability of a cure. “At many cancer treatment centers, these patients only get chemotherapy and have no chance at definitive treatment. The goal of treatment is solely to prevent or delay symptoms from developing and they are seen as incurable,” he said. “But with re-irradiation, our study shows that maybe we can give a curative intent treatment that we couldn’t do in the past. It’s a layer of hope for some patients that they never had before.”

The researchers reviewed 11 years of clinical research for the study. Eighty-six patients were identified who received at least two sequences of thoracic radiotherapy. Of that number, 33 were treated with repeat thoracic radiotherapy using stereotactic body radiation therapy (SBRT) or accelerated hypofractionated radiotherapy (AHRT), as a component of their treatment. The median age was 66 and the majority of patients (88%) were treated for primary lung cancer. The median tumor size at retreatment was 2.5 cm. Earlier lung resections had been performed in 24% of patients.

Dr. Urbanic noted that the typical patient is an older man or woman who got treated with either chemotherapy and radiation or radiation by itself for a lung cancer that could not be surgically removed. They have returned for a checkup and feel well, but a computed tomography (CT) scan shows that the cancer has returned in the area earlier treated. If the cancer is just in one area, the patients get retreated with 10 radiation treatments done with the SBRT technique which is tightly targeted to just the tumor and minimizes the dose to the neighboring healthy tissue.

“Wake Forest Baptist has been developing expertise in doing this,” Dr. Urbanic said. “We’re finding that there are patients who are alive years later. We have seen relatively modest toxicity and a good ability to try and control the disease upwards of 70% of the time.”

However, there is a higher risk of injury involved when someone is radiated a second time which is why other cancer treatment center programs might be reluctant to adopt the practice, Dr. Urbanic reported. “This is a fairly niche effort in lung cancer care, and we’d like to see a national level clinical trial at some point,” Dr. Urbanic said. “The technology has gotten to the point where I think it’s going to allow radiation oncologists to reassess their ability so that maybe they can take risks they weren’t willing to take before. Eventually, this practice will become more widespread.”

Related Links:
Comprehensive Cancer Center of Wake Forest Baptist Medical Center