Procedure
Radiotherapy can also be used if the lung cancer has already spread: radiotherapy can then prevent or alleviate symptoms caused by metastases, e.g. in the brain or bones(palliative radiotherapy).
Radiation therapy is performed as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can thus be easily integrated into everyday private and professional life. Depending on the extent of the tumor, radiotherapy can be carried out in one or a few treatment sessions as radiosurgery for small tumor foci, or as fractionated treatment over several weeks for larger tumors. Radiation therapy is often combined with chemotherapy or immunotherapy to improve efficacy. Close and personal support is a matter of course for us.
The Department of Radiation Oncology at the USZ uses only the most modern techniques for precise radiation treatment of lung cancer with few side effects. They are supervised by internationally recognized experts in the research and treatment of lung cancer.
For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working on improving the treatment of lung cancer to make it even more effective and tolerable. To the overview of currently open studies.
In the following, we will describe radiotherapy for the different types and stages of lung cancer.
Early-stage non-small cell lung cancer
In early-stage non-small cell lung cancer (NSCLC), surgical removal of the tumor is the treatment of first choice for fit patients. For older patients, those with poor lung function or with underlying conditions such as heart disease that make anesthesia risky, so-called body stereotactic radiation therapy (SBRT) is an alternative treatment that is equivalent to surgery. Highly focused radiation can kill the lung tumor and achieve a cure in the vast majority of patients.
Body stereotactic radiotherapy (SBRT) kills the tumor in very few radiotherapy sessions: typically five outpatient radiotherapy sessions over 30 minutes. This is achieved by highly focused irradiation with an accuracy in the millimeter range.
Body stereotactic radiotherapy (SBRT) is a clinical and scientific focus of our clinic: Prof. M. Guckenberger and Prof. N. Andratschke have been instrumental in developing this method and we pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.
In clinical trials, we are continuously trying to improve the treatment of lung cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
- A collaborative analysis of stereotactic lung radiotherapy outcomes for early-stage non-small-cell lung cancer using daily online cone-beam computed tomography image-guided radiotherapy. Grills IS (and Guckenberger M) J Thorac Oncol. 2012 Sep;7(9):1382-93.
- Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomized trials. Chang et al. Lancet Oncol. 2015 Jun;16(6):630-7.
Non-small cell lung cancer in the locally advanced stage
In locally advanced non-small cell lung cancer (NSCLC), when the tumor has already spread to the lymph glands, the tumor needs to be surgically removed or irradiated. Chemotherapy is also necessary to eliminate any cancer cells that may have spread. Depending on the extent of the tumor, surgery, radiotherapy and chemotherapy may also be necessary (trimodal therapy).
One important innovation is immunotherapy, which is used after radiotherapy and has significantly improved the survival of patients with lung cancer. Due to the often extensive tumor, the radiation is divided into many small “portions”: the therapy is fractionated over about 30 treatment sessions every working day over a period of about 6 weeks. Spreading the radiation treatment over several weeks improves the tolerability of the treatment, which is mainly carried out on an outpatient basis and can be integrated into everyday private and professional life.
Radiotherapy of lung cancer is a clinical and scientific focus of our clinic and of Prof. M. Guckenberger and Prof. N. Andratschke. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in surgery and medical oncology in order to guarantee treatment “from a single source”.
In clinical trials, we are continuously trying to improve the treatment of lung cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
- Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. Antonia SJ, N Engl J Med. 2018 Dec 13;379(24):2342-2350.
- Progression-Free and Overall Survival for Concurrent Nivolumab With Standard Concurrent Chemoradiotherapy in Locally Advanced Stage IIIA-B NSCLC: Results From the European Thoracic Oncology Platform NICOLAS Phase II Trial (European Thoracic Oncology Platform 6-14). Peters S, (and Guckenberger M, Andratschke N) J Thorac Oncol. 2021 Feb;16(2):278-288.
Oligometastatic non-small cell lung cancer
When non-small cell lung cancer (NSCLC) has spread, i.e. metastasized, it was historically believed that a cure was no longer possible; consequently, patients were “only” treated with chemotherapy. Today we know that this has to be considered in a more differentiated way: if the lung cancer has only formed a few metastases (maximum 3-5) then we supplement chemotherapy (or immunotherapy and targeted therapy) with radiotherapy (or surgery) of all cancer foci: The aim is not only to shrink the cancer, but to eliminate it completely. In a relevant proportion of patients, a cure or at least long-term tumor control can be achieved.
Body stereotactic radiotherapy (SBRT), a highly focused radiation treatment in just a few outpatient treatment sessions, is the best-studied local treatment method in this situation of oligometastasis. Body stereotactic radiation can combat metastases in almost all regions of the body highly effectively and with few side effects: metastases in lymph nodes, the lungs, the liver, the adrenal glands, in the brain and in bones. Tumor foci in distant regions can be treated in a single treatment session; unlike surgery, two separate procedures are not required. An optimal combination of local radiotherapy and systemic therapy is also important.
For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.
Oligometastatic lung cancer is a clinical and scientific focus of our clinic and of Prof. M. Guckenberger and Prof. N. Andratschke. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology and surgery in order to guarantee treatment “from a single source”.
In clinical trials, we are continuously trying to improve the treatment of lung cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
- Characterization and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Guckenberger M, Lancet Oncol. 2020 Jan;21(1):e18-e28.
- Definition of Synchronous Oligometastatic Non-Small Cell Lung Cancer-A Consensus Report. Dingemans AC (and Guckenberger M) J Thorac Oncol. 2019 Dec;14(12):2109-2119.
Metastases of non-small cell lung cancer, e.g. in the brain or bones
Lung cancer is an aggressive type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.
For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.
Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery. Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions. Metastatic lung cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions.
State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.
In clinical trials, we are continuously trying to improve the treatment of lung cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
- Optimal management of brain metastases in oncogenic-driven non-small cell lung cancer (NSCLC). Andratschke N, . .. Guckenberger M. Lung Cancer. 2019 Mar;129:63-71.
- Management of patients with brain metastases from non-small cell lung cancer and adverse prognostic features: multi-national radiation treatment recommendations are heterogeneous. Nieder C (and Guckenberger M) Radiat Oncol. 2019 Feb 15;14(1):33.
Small cell lung carcinoma
Small cell lung carcinoma is an aggressive type of cancer, but it reacts very sensitively to chemotherapy and radiotherapy.
In the limited stage, known as “limited disease”, we treat our patients together with our colleagues in medical oncology. After the first dose of chemotherapy, radiotherapy and simultaneous chemotherapy are administered. The aim is to kill the entire tumor. The treatment of the lung tumor is followed by low-dose radiation of the brain. This is necessary because in small cell lung carcinoma, individual cells very often spread to the brain: Radiation kills these few cells before they can continue to grow and cause symptoms.
In the advanced stage with the presence of metastases, referred to as “extensive disease”, chemotherapy combined with immunotherapy is the first treatment component. If the tumor responds well to this treatment, it is followed by a short two to three-week course of radiotherapy to treat the tumor in the lung even more effectively.
Metastatic lung cancer is a clinical and scientific focus of our clinic and of Prof. M. Guckenberger and Prof. N. Andratschke. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.
In clinical trials, we are continuously trying to improve the treatment of lung cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
- Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomized, superiority trial. Faivre-Finn C, Lancet Oncol. 2017 Aug;18(8):1116-1125.
- Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomized controlled trial. Slotman BJ, Lancet. 2015 Jan 3;385(9962):36-42.
