Based on a new study, an old concept of re-treating lung tumors has come back into the fold, this time with modern technology on its side.
The Comprehensive Cancer Center of Wake Forest Baptist Medical Center is one of only several cancer centers that is trying to give lung cancer patients out of treatment options a chance to contain the cancer.
For these patients, hope lies in a second round of treatment i.e. repeat radiation. Two complementary papers published back-to-back recently in the journal Radiotherapy and Oncology and the Journal of Thoracic Oncology delineates 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. With some of the technological advances in radiation treatments that have occurred in the last five 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? ," said lead author of the studies and a radiation oncologist at Wake Forest Baptist, James J. Urbanic, M.D.
Urbanic also noted that the overall discoveries made by the study indicate that there are some patients with recurrent lung cancers who can be treated with another definitive round of radiation therapy and still have a plausible shot at complete recovery.
"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."
For this study, the researchers took a second look at 11 years of clinical data. Eighty-six patients were distinguished who underwent at least two sessions of thoracic radiotherapy.
From those patients, 33 were treated with repeat thoracic radiotherapy using stereotactic body radiation therapy (SBRT) or accelerated hypofractionated radiotherapy (AHRT), as a factor of their treatment. The average age of patients was 66 and the majority of patients (88 percent) were treated for primary lung cancer. Median tumor size at re-treatment was 2.5 cm. Previous lung resections had been performed in 24 percent of patients.
Urbanic mentioned that the usual patient is an older man or woman who received treatment with either chemotherapy and radiation or radiation alone for a lung cancer that couldn't be surgically eliminated. The patients returned for a checkup and felt well, however a CT scan depicted that the cancer recurred in the area previously treated. If the cancer is remained in one spot, the patients would receive retreatment with 10 radiation treatments performed with the SBRT technique which is tightly targeted to just the tumor and minimizes the dose and risk of damage to the surrounding normal tissue.
"Wake Forest Baptist has been developing expertise in doing this. 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 percent of the time," said Urbanic.
However, there is a high risk of injury involved when a patient receives radiation for a second time, which could be a reason on why other cancer treatment centers may be skeptical and hesitant on adopting this practice of retreatment.
"This is a fairly niche effort in lung cancer care, and we'd like to see a national level clinical trial at some point. 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," said Urbanic.
