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What State-of-the-Art Radiation Therapies Are Helping Lung Cancer Patients?

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Published on October 24, 2016

Is radiation therapy right for you? Stage IV lung cancer survivor and patient advocate, Janet Freeman-Daily, guest hosts this interview with Dr. Timothy Kruser of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Dr. Kruser explains the top three state-of-the-art radiation therapy options for lung cancer patients and how science and medicine continue to work together to minimize side effects for the patient.

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Transcript | What State-of-the-Art Radiation Therapies Are Helping Lung Cancer Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Janet Freeman-Daily:

Hi. I'm Janet Freeman?Daily, a lung cancer patient and activist, and I'm here with Dr. Timothy Kruser from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and he is an assistant professor in radiation oncology.  Welcome.

Dr. Kruser:

Thanks, Janet, for having me. 

Janet Freeman?Daily:

So we have some questions for you, Dr. Kruser.  Can you briefly discuss some the state?of?the?art radiation treatment options right now that you're really excited about? 

Dr. Kruser:

There [have] been a lot of advances in radiation oncology recently.  IMRT came into…

Janet Freeman?Daily:

…IMRT is? 

Dr. Kruser:

Intensity modulated radiation therapy. It's a way of creating curved radiation dose depositions.  So rather than just treating a straight front and back radiation field like they did in the ‘80s and ‘90s, this allows us to specifically tailor the radiation to the tumor and minimize the dose through things like the esophagus, the heart, the uninvolved lung, which can contribute a lot to side effects.  So that's something that really came into maturity and development in the late ‘90s or early 2000s, and we're now looking at steps beyond that.  

Proton beam radiation therapy is something we have available here at Northwestern.  That also is a new technique, which further has the ability to minimize dose to those involved organs like the esophagus and heart.

Also there are new techniques called stereotactic body radiation, or SBRT, and that is using a small number of radiation treatments to smaller tumors and delivering a large dose per day and allowing us to get the treatment done quickly and get very good local control rates, which seem to be on par with surgical excision for patients with early?stage lung cancer. 

Janet Freeman?Daily:

So is any patient who has a small tumor eligible for SBRT? 

Dr. Kruser:

Surgical excision or lobectomy still remains the standard of care in most situations, but a lot of people with lung cancer have other medical problems like heart problems or poor lung function because of smoking in many cases, which makes a lobectomy difficult or dangerous. So in those situations, SBRT is often used as an alternative to surgery and seems to offer probably equivalent control rates.

Janet Freeman?Daily:

Are there any cases where the location of a tumor makes SBRT not workable?  

Dr. Kruser:

There are—there are locations where it's a little bit more difficult from a technical standpoint.  Sometimes we soften up the dose a little bit if the tumor is right near the ribs, for example.  Using the aggressive SBRT approach can put someone at risk for some chest wall pain or rib fracture, so sometimes we'll use some techniques to minimize that, but there are ways around those issues. 

Janet Freeman?Daily:

Okay. You mentioned chest wall pain and some other issues. Now that many lung cancer patients are living longer, especially with targeted therapy assist other treatments, are you seeing more long?term side effects from radiation?

Dr. Kruser:

You know, long?term side effects are always something we're worried about when we're treating people, and that's where a lot of the research and efforts are going in terms of making our radiation treatments better. 

So over the last decade or so we've started to, for example, very precisely monitor how much a tumor moves during radiation so that we can very fine-tune the amount of what we call a margin we need to use.  So we use a smaller volume or smaller region of radiation if we're able to watch the tumor move and track it.  And so that's one way we're able to potentially minimize the side effects in the long term. 

Janet Freeman?Daily:

And you mentioned that moving, sometimes the patients might move during this, and I guess there [are] some new developments in technology also to make it easier for the radiation to focus in on the tumor even if the patient happens to move? 

Dr. Kruser:

That's true.  We make a lot of efforts to make sure that the patient's—is held in a very reproducible position, so a lot of our efforts go into immobilization, minimizing a little bit the amount the diaphragm moves as they breathe. So we try to have people breathe kind of up through their shoulders rather than down through their belly, so we coax them on breathing techniques, all in an effort to make the radiation more precise and better tolerated.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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