Ask the Expert Tip on Treatment for Stage III Lung Cancer

David M. Jackman, MD from Dana-Farber Cancer Institute recently answered your questions on lung cancer as part of CancerConnect’s Guest Moderator Ask the Expert series. Dr. Jackman is a thoracic oncologist in the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute.

Question:  My sister has stage 3 lung cancer and presented with anemia, nausea and weight loss. They didn’t want to treat her until they figured out what was going on with the nausea so we waited for 2 months while they did tests. Now they are finally moving, but still don’t know why she is anemic and can barely eat. We meet with the radiation oncologist Friday and want to know what to ask. Is there a specific kind of treatment modality we should be asking about? Tomotherapy, cyberknife, proton therapy? I just don’t know enough about it. We are near enough to Chicago that we have everything available, just want to make sure our physician offers the best option.

Dr. Jackman’s Response:  When we think about Stage III lung cancer generally, we think about providing both local therapy (radiation and/or surgery) as well as systemic therapy (chemotherapy).  There is not one standard approach, and the specifics of the choice and timing of the local therapies may vary from center to center.  With respect to radiotherapy in stage III lung cancer, we often consider delivering radiation together with chemotherapy in those patients who are well enough to handle this combination.  The radiation should be delivered conformally – that is, the radiation field is shaped to encompass the areas of tumor involvement so as to try to optimize the delivery of radiation to tumor and limit the dose of radiation to surrounding normal tissues.

We generally do not use cyberknife nor proton therapy in radiation for stage III lung cancer.  “Cyberknife” is a form of what we call stereotactic radiation, delivering a very focused beam of radiation to a small, well defined area.  In lung cancer, this is primarily used in small, local tumors that haven’t spread and would otherwise have been surgically removed but the patient cannot tolerate a surgical operation for some reason.  It is not feasible for larger fields in which we have to irradiate both a tumor and mediastinal lymph nodes, as in most cases of stage III lung cancer.  Furthermore, the safety of stereotactic radiation for tumors located toward the center of the chest is a major concern due to the potential deleterious effect on some of the main airways in that area.

Proton therapy is an exciting advance in radiation therapy, but its use in lung cancer remains investigational.  There are technical challenges surrounding the delivery of protons to lung tumors, so that this type of radiation has not been adopted as the standard practice at this time.

To learn more about the Guest Moderator Ask the Expert Series with Dr. Jackman, click here. To access discussions like these on CancerConnect, check out the lung cancer community here. CancerConnect is a unique online network for people with cancer and their caregivers. This dedicated social network provides a safe and secure environment for individuals interested in cancer to learn, support, and connect with others who have similar issues and concerns. There are currently over 60 CancerConnect “groups” dedicated to topics related to breast, colon, lung, prostate, and many other cancer types. In addition, groups are also sharing information and insight into their personal experiences with caregiving, genetic testing, screening, prevention, health and wellness, and supportive care topics.

The information contained above is general in nature and is not intended as a guide to self-medication by consumers or meant to substitute for advice provided by your own physician or other medical professional.