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Expert Analysis Highlights:
Radiation has been used successfully to treat lung and other cancers for over 50 years. During this period, there have been numerous technology advances that have allowed for higher dosages of radiation to be selectively delivered to the tumor while sparing dose to the normal tissues. Most recently, these advances have led to “stereotactic” radiation treatments of lung tumors, which were nicely described in this video. The goal of this type of treatment is to deliver very high ablative dosages of radiation in a very precise fashion to the tumor. Multiple sites of beam entrances are used and all these beams then intersect within the tumor in order to provide this very high dose. While conventionally, radiation treatments for lung cancer were given in 25-35 treatments, stereotactic approaches usually use only 1-5 treatments.
The largest experiences in using this approach have been for patients with small tumors that are located away from central structures in the chest. Historically, these types of patients have been successfully treated with surgical resection. Accordingly, it was in patients with poor lung functions who are not candidates for surgery that stereotactic treatments were first explored. The results from these studies have shown the treatment to be highly effective. The chance of eradicating the disease without the need for any surgical intervention is very high for appropriately selected patients. Based on these data, there are now ongoing national/international studies to directly compare this new radiation approach versus surgical resection.
As suggested in the video, stereotactic treatments of lung cancer requires sophisticated technology including methods to manage the tumor motion due to breathing and image guidance to assure that the precise radiation delivery appropriately hits its target. Equally important to the technology and equipment is the staff and physician experience. Fortunately, this technology is now becoming more widely adopted and more centers are gaining experience with this new and promising approach.