Lung Cancer Treatments

Specialists at Beaumont Cancer Institute use surgery, chemotherapy and radiation to treat lung cancer. Specific treatments are based on the type and stage of the disease and the patient’s medical condition and preferences.

• Stage I and II non-small cell lung cancers – treatment of these early stage lung cancers begins with surgical removal of the tumor and examination of the nearby lymph nodes to see if the cancer has spread. Radiation is not typically offered after surgery.
• Stage IB (T2 NO) or higher – chemotherapy is maybe offered to healthy patients after surgery.
• Stage III – the management of this stage of lung cancer is very complex. Many possible treatment options exist, and the thoracic surgeon, medical oncologist and radiation oncologist will work together to find the most suitable treatment. Possible treatment options include:
  • chemotherapy followed by surgery
  • chemotherapy and radiation followed by surgery
  • chemotherapy and radiation without surgery
  • chemotherapy followed by radiation
  • chemotherapy and radiation given at the same time
  • surgery followed by chemotherapy, with or without radiation
  • chemotherapy alone
• Medically inoperable lung cancer – if major medical problems or severe lung disease (emphysema/COPD) make surgery too risky, radiation is often the best treatment option. Depending on the type of radiation, chemotherapy may be given at the same time as radiation, before radiation or after radiation is over. Some patients with Stage I or II medically inoperable lung cancer are candidates for lung SRS (stereotactic radiosurgery). Phase I and II clinical trials of lung SRS show significantly better tumor control and cure rates than with standard radiation. The potential for side effects may also be slightly higher.
• Metastatic lung cancer – “metastatic” refers to cancer that has spread outside of the lung and/or lymph nodes to other parts of the body. This type of cancer can be treated but not usually cured. Treatment depends on where the cancer has spread and the symptoms it causes. Most metastatic cancer is treated with chemotherapy, but radiation may also be used. For example, radiation may relieve difficult breathing or treat brain tumors that chemotherapy cannot easily reach. Two types of radiation therapy may be used on the brain:
  • whole brain radiation that treats the entire brain
  • stereotactic radiosurgery, a single high-dose treatment to an isolated tumor

Surgery

Surgery generally involves opening the chest to examine the lungs and see if cancer has spread to the lymph nodes. Chest (thoracic) surgeons use a variety of surgical procedures.

• thoracotomy – opening of the chest.
• lymph node dissection – sampling of lymph nodes in the chest to see if cancer has spread.
• surgical resection – removal of the tumor.
• wedge resection – removal of a portion of the lung.
• lobectomy – removal of one lobe of the lung.
• pneumonectomy – removal of an entire lung.

The type of surgery depends on overall health, lung function, tumor location and the stage of lung cancer.

Chemotherapy

Chemotherapy uses various kinds drugs to treat lung cancer. They may be administered orally or through the veins (intravenously). Drugs that travel throughout the whole body are called systemic, because they affect the whole system. They attack the main tumor site but also reduce the chances of cancer in other areas. Some chemotherapy acts to “sensitize” cells so that radiation therapy works better.

Common side effects of chemotherapy include

• lowered blood counts
• nausea and vomiting
• hair loss

Not all drugs have these side effects, and steps can be taken to manage most side effects.

A medical oncologist oversees chemotherapy and will talk to the patient about treatment and will work with other specialists to coordinate care.

Radiation

The Radiation Oncology department at Beaumont features high-tech equipment that is minimally invasive and helps preserve quality of life. For example, the Axesse® or Omni Beam® machine, the first of its kind in the world, improves radiation therapy for lung cancer by more precisely targeting cancer cells and sparing normal tissue.

Different types of equipment are used to target cancer cells and procedures for delivering radiation treatment.

• PET and CT scans – these multi-dimension images aid in accurately targeting tumors and ensuring that all abnormal areas are included in the treatment plan. A diagnostic scan may be used or a new scan taken in the planned treatment position. PET scans are not always used for small cell lung cancers, because they have not been well studied for this type of cancer.
• External beam radiation therapy (EBRT) – a linear accelerator delivers a series of painless, daily treatments that accurately target the lung or lung and abnormal lymph nodes. Each session takes approximately 30 minutes, Monday through Friday, usually for six to seven weeks. Most of each session is devoted to properly positioning you. The radiation treatments typically last for only a few minutes.
  The treatment begins with a planning session in which a foam cradle is made to hold the patient during treatment. After the cradle is made, a CT scan is done to identify the area to be treated and to calculate the dose to be delivered. If breathing causes significant motion of the tumor, a four-dimensional CT scan (4DCT) that adapts by taking breathing into account may be used. This is called adaptive radiotherapy. The radiation oncologist may also fuse PET and CT scans to improve the accuracy of targeting.
  Beaumont’s Radiation Oncology department has been extensively involved in research designed to significantly improve lung radiotherapy through CT-PET fusion and 4DCT adaptive planning. Beaumont’s radiation oncologists and physicists are helping to develop national protocols and clinical trials through the Radiation Therapy Oncology Group (RTOG) investigating 4DCT and Cone Beam CT.
• Extra-cranial stereotactic radiosurgery of the lung (lung SRS) – multiple X-ray beams, usually seven to 10, are directed at the tumor with a small amount of margin. Treatments are given in four or five fractions over approximately eight to 14 days, rather than over seven weeks, as with standard radiation. The dose of radiation delivered with lung SRS is also much higher than a dose of standard radiation. The time necessary to set up and deliver lung SRS is around 45 minutes to an hour.
  Secure and reproducible positioning is crucial to hitting targeted tissue with lung SRS. A specialized foam cradle is required to limit motion. In addition, a 4DCT may be necessary to compensate for breathing. Medications can be given before treatment to help you relax and to reduce discomfort.
  The Synergy, Axesse® or Omni Beam® machine that delivers lung SRS combines a linear accelerator with a cone beam CT scanner. The tumor position is confirmed by the scanner just before treatment begins to be sure the X-rays are targeted directly at the tumor.
  Beaumont is one of a select number of institutions nationally and internationally that offer lung SRS. The Synergy machine was developed by physicists at Beaumont. Lung SRS is offered as part of an in-house investigational study being conducted at Beaumont, Royal Oak.
• Intensity modulated radiation therapy (IMRT) allows radiation to be focused on hot spots like tumors, where the dose should be high, and on cold spots like nearby normal tissue, where the dose should be low. At Beaumont, IMRT is used selectively when medically appropriate. Beaumont was one of the first institutions in the world to develop and use IMRT.
• Endobronchial brachytherapy uses a radiation source temporarily positioned internally, close to the area to be treated. “Endobronchial” means inside the windpipe that leads to the lungs. A thoracic surgeon or pulmonologist positions the radioactive source using a bronchoscope.

Side Effects of Radiation

The side effects of radiation are felt mainly at the site of treatment, although general fatigue is common. Other side effects include:

• lower blood counts, which will be monitored weekly if both radiation and chemotherapy are being administered.
• mild skin irritation on the chest.
• irritation of the esophagus (tube connecting the mouth to the stomach). This symptom is usually temporary but may be worse if radiation and chemotherapy are given together. Rarely, esophageal irritation can be severe, leading to dehydration or other complications.
• radiation pneumonitis or pneumonia. Radiation can inflame the lung tissue, causing coughing, shortness of breath and sometimes fever. There is no infection, however. Radiation pneumonitis can be treated, but in severe cases supplemental oxygen or a ventilator become necessary.

Radiation oncologists at Beaumont use very precise equipment to target radiation only at the tumor and thus limit its side effects as much as possible.

Clinical Trials

The radiation oncology team at Beaumont is always exploring new ways to improve outcomes through research studies called clinical trials. These studies may be offered just at Beaumont or through national research organizations. Today’s radiation therapies resulted from clinical trials completed years ago proving that radiation kills cancer cells and can be administered safely. Learn more about Research & Clinical Trials at Beaumont.