Radiotherapy of Lung Cancer
Epidemiology: lung cancer is the most frequent cancer in men and 5th in women. Morbidity rises with age – the peak at 70-74 of age
Etiology: smoking, occupational carcinogenic hazards (radon/asbestos), air pollutants.
Clinical symptoms: dyspnoea, haemoptysis, weight loss, chest pain, hoarseness, paraneoplastic syndrome and SVCS
Diagnostic: physical examination, chest CT, blood count.
Histologically two major groups
- Non-small cell lung cancer (NSCLC). 85% of the cases (giant cell carcinoma, adenocarcinoma, squamous cell carcinoma).
- Small-cell lung cancer (SCLC). 15% of the cases
TNM staging
T1 – <3cm in dimension, surrounded by lung of visceral pleura
T2 – >3cm but <7cm with any of the following; involved main bronchus, invades visceral pleura, and associated with atelectasis
T3 – >7cm, it directly invades the chest wall, diaphragm, phrenic nerve and mediastinal pleura.
T4 – tumour of any size that invades any of the following; heart, trachea, oesophagus recurrent laryngeal nerve, mediastinum.
N0 – no regional lymph nodes metastasis
N1 – metastasis in ipsilateral pericronchial and/or hilar lymph nodes and intrapulmonary LN
N2 – Ipsilateral mediastinal and/or subcarinal lymph nodes
N3- Hilar lymph nodes and supraclavicular & ipsilateral or contralateral scalene
M0 – no distant metastasis
M1a – separate tumour nodules in a contralateral lobe
M1b – distant metastasis
Radiotherapy
- Preoperative stage 2 & 3a > (30Gy total dose) and surgery in 10-14 days
- Postoperative stage 3 (50-60Gy total dose)
- Definitive RT (50-60Gy)
- Palliative treatment
Follow up
- Initial after RT – 4/6weeks
- Within the 2nd year – every 4-6 month
- After 3rd year – once yearly
- clinical test & CT