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Overview

Lung cancer, which takes many forms, is a common form of cancer. Some case of lung cancer grow slowly and are not life-threatening; others spread aggressively throughout the body. Good treatment options are available when lung cancer is diagnosed early and growths are confined to the lungs.

Among the most promising options is stereotactic body radiotherapy (SBRT), also known as radiosurgery. This is an accurate, high-dose, noninvasive radiation procedure that can cure some cases of lung cancer. Yale Medicine, a long-time leader in treating lung cancer patients with SBRT, has exceptional experience honed over many years. 

What are the common types of lung cancer, and how does treatment, including SBRT, vary?

Treatment for lung cancer varies significantly, depending on the stage of the cancer and such factors as the patient’s age and overall health, and whether the cancer has spread.

For earlier lung cancers, including Stage I (where tumors are isolated in the lungs) as well as Stages II and III (where the cancer has spread to nearby lymph nodes), the goal is to cure the patient. For Stage IV cancer (which has spread to organs beyond the lungs), the goal is not to eradicate the cancer, but to prolong and improve quality of life. “We can often hold it in check for a long time,” says Roy Decker, MD, director of the Yale Medicine Thoracic Radiotherapy Program, who has helped make SBRT instrumental in lung-cancer care.

Who is eligible for SBRT (radiosurgery) for lung cancer?

People with cancers that are small and contained are good candidates for SBRT (radiosurgery). Thanks to increased use of computerized tomography (CT) scanning, doctors are more likely to catch lung cancer earlier. That means that more patients are eligible for therapy that gets rid of the cancer instead of treatment that merely eases symptoms. Many patients with early-stage lung cancer will have resection (surgical removal of the tumor), but SBRT (radiosurgery) is a promising option for patients too sick for invasive surgery due to lung or heart conditions, or for those who prefer a noninvasive treatment.

For those with more advanced cancer, doctors might use radiation in combination with a systemic treatment like chemotherapy.

How is SBRT (radiosurgery) combined with such other treatments as surgery and chemotherapy?

Radiation can be the sole treatment for patients with early-stage lung cancer or small metastases. When the cancer has spread to the lymph nodes in the middle of the chest (late-stage lung cancer), doctors may manage it with a combination of chemotherapy and radiotherapy.

For patients with metastatic lung cancer that has spread to organs beyond the lung, the primary therapy is likely chemotherapy or immunotherapy. Radiation may be used as a palliative therapy, not to alleviate the cancer, but to improve quality of life and reduce discomfort. “The role of radiation in these patients is to treat a disease site that is painful, or that obstructs an airway and thereby inhibiting breathing,” Dr. Decker says. 

What should a patient expect during SBRT?

Initial treatment involves scans, procedures, and biopsies to understand the nature of the tumor, if and how it has spread, and its genetic makeup.

“When we’re making a decision about a patient, we like to consider all individual factors, such as potential side effects of a treatment and possible alternatives to that treatment,” Dr. Decker says.

At Yale Medicine, if, after an evaluation, doctors decide radiation is the right course, radiologists scan and measure the treatment area. "This is an especially important step," says Dr. Decker, "because the lungs move up and down as a person breathes, whereas, other organs do not and can be immobilized." Next, the team creates a strategy for radiation dosing, and the patient returns for treatment sessions, which typically last a half-hour. SBRT (radiosurgery) may require anywhere from one to five treatments, given over a week or two. For more extended, fractionated radiation, treatment can span two to six weeks.

How successful is SBRT treatment?

Yale Medicine's success rates for patients with small isolated tumors and for patients with locally advanced cancers are high. Still, it’s important to understand that for more advanced cancers, success is not always defined as a cure. Sometimes, instead of eliminating the cancer, the goal of treatment is alleviate a part of the cancer that is especially painful, and to enhance quality of life.

What are the potential side effects of SBRT (radiosurgery)?

“When I meet with a patient, we have a frank discussion about potential risks and side effects of radiosurgery,” Dr. Decker says. He helps patients compare and contrast the risks with the overall goals of treatment.

A patient who's heard negatives about radiation treatments of the past may worry about side effects. But technological advances have allowed treatments at Yale Medicine to become more accurate, shorter and more effective. Most patients have few side effects, with the exception of some who experience fatigue or shortness of breath.

Other side effects are closely related to the location and size of the tumor (for example, radiation damage to the skin may be seen when the tumor is located near the skin's surface). Rarely, radiation may cause long-term damage to lung function; Yale Medicine works hard to limit this risk when treatment planning.

What makes Yale Medicine’s approach to SBRT (radiosurgery) for lung cancer unique?

Yale Medicine’s thoracic oncology program is large and robust, filled with specialists who have a breadth of knowledge and experience culled from various disciplines and practices. Together, these experts create individualized treatment plans based on a person’s cancer and overall health.

"Because Yale Medicine has been practicing stereotactic body radiotherapy for many years, we have the kind of expertise that comes with being the longtime leader in the field," Dr. Decker says. "Advanced technology enables our team to scrutinize a tumor to learn as much as possible before treatment. And the department has also invested in the best and newest equipment to help radiologists deliver doses with extreme precision and plan better," Dr. Decker says.

Yale Medicine radiologists can also access molecular profiling, performed by pathologists to sequence and analyze small portions of cancerous tissue. The radiologists look for mutations, which can help predict the behavior of a tumor and how it will react to radiation, chemotherapy or medication. Profiling can also help match patients with relevant experimental therapies or clinical trials.