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Cancer Surgery and Radiation Therapy Considered

Treatment of Early-Stage Non-Small Cell Lung Cancer Reviewed

September 14, 2001 -- A medical researcher at MD Anderson Cancer Center has reviewed the treatment options for patients with non-small-cell lung cancer (NSCLC) diagnosed as stage I or II (Dr. W. Roy Smythe, Cancer Control; JMCC 8(4):318-325). A minority among lung cancer victims, these early-stage cancer patients stand a better chance of survival than those with more advanced cancer, if provided with the appropriate treatment.

Surgery for Stage I and II NSCLC as "Standard of Care"

According to the medical researcher, the best proven methods for treatment of patients with stage I and II NSCLC are surgical resection and radiation therapy. Various studies show that limited lung resection (called "wedge resection" or "segmentectomy") is not as reliable as a lobectomy, which is the removal of the lobe of a lung. In one 12-year study at Memorial Sloan-Kettering Cancer Center, investigators evaluated limited resection vs. lobectomy in more than 500 patients. The 5- and 10-year survival rates in those undergoing limited resection were 59% and 35%, respectively, compared with 77% and 70% in those undergoing lobectomy.

Not all patients can withstand the rigors of surgery, especially a procedure as radical as a lobectomy. Therefore, care should be taken to identify problems that may lead to either a greater risk of postoperative complications or a need to more carefully evaluate for advanced or metastatic tumors.

Radiation Therapy

A number of published reports have recently appeared in the literature describing radiation as definitive therapy for patients with early-stage NSCLC. In one study, 86% of stage I cancer patients treated with proton-beam radiation therapy remained disease-free after 2 years. These results suggest that a 5-year survival rate of 30% may be expected. Proton-beam radiation therapy is one of the newer forms of radiation therapy that may be used to treat localized, isolated tumors before they spread to other tissues. Using protons rather than conventional photons or X-rays may more accurately pinpoint the cancerous cells and have less effect on surrounding healthy tissue.

Other new radiation therapies hold some promise. These include hyperfractionated radiation and intensity-modulated radiotherapy. Hyperfractionated radiation is treatment that is given in smaller-than-usual doses more frequently than once a day. Doctors are studying hyperfractionated therapy to learn whether it is more effective than once-a-day therapy and has fewer long-term side effects. Intensity-modulated radiotherapy is a type of three-dimensional radiotherapy whose path changes to match the shape of the tumor and whose intensity varies to match its depth. This may provide a more precise way of targeting cancer cells than other radiation methods.

The Future

In the future, gene therapy, thermal techniques (heat treatment) and advanced radiation therapy methods may supplant the need to surgically resect tumors in early-stage lung cancer patients.

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