• Posted January 12, 2024

Treatment Approach Effective When Surgery Not an Option for Lung Cancer

Lung cancer patients who are unsuitable candidates for surgery may have a new, effective treatment option, researchers report.

In a small study -- just 28 patients -- investigators found that delivering higher but less frequent doses of radiation therapy, along with standard chemotherapy, upped survival rates in these cases.

“Our data shows patients may benefit from targeted, high-dose radiation with chemotherapy if it's done thoughtfully with adaptive radiation,” said study author Dr. Beth Neilsen, a radiation oncology resident at UCLA.

"Adaptive" radiation means that doctors may tailor radiation doses based on an individual patient's initial response to the treatment.

The study focused on patients whose non-small cell lung cancers had advanced within the lungs but for whatever reason were not candidates for surgery to remove the tumor.

In the past, these patients have been treated with a standard radiation-plus-chemotherapy approach, but survival rates have been low. That regimen consisted of 30 treatments given over six weeks.

Neilsen's team wanted to try a new, more nuanced radiation strategy.

They focused on "using a novel adaptive boost technique personalized to an individual's treatment response after the first two-thirds of radiation treatment," study lead author Dr. Trudy Wu explained in a university news release. She's a radiation oncology resident at UCLA.

Instead of using dozens of smaller-dose treatments, the Los Angeles doctors used higher doses given less frequently. They theorized that more intense doses might help eradicate the tumor and prevent a recurrence.

The trick was to find the ideal dose that could boost survival, but with the least damage to healthy tissue.

To do so, they enrolled 28 patients with stage 2 or 3 lung cancer in an "early phase dose-escalation trial."

Patients received the new doses of radiation (along with chemotherapy) at low, intermediate and high doses.

The "sweet spot" in terms of safety and effectiveness occurred with the intermediate dose, the researchers reported Jan. 11 in the journal JAMA Oncology.

Looking at two-year survival rates, just over 76% of patients who got the intermediate dose of radiation were still alive, compared to 30% of those who got the low dose and about 56% of those who got the high dose.

In terms of rates of two-year tumor recurrence, results were best among those who got the highest dose of radiation, but their side effects were much more severe, the UCLA team said.

On the other hand, patients who received the intermediate radiation dosage had no severe side effects. If side effects did occur, they typically involved fatigue and/or inflammation of the esophagus or lungs resulting in sore throat or cough.

The researchers acknowledge that the study sample size was small, and that larger studies with longer follow-up are needed.

Still, “this study contributes to ongoing efforts to improve the treatment lung cancer, a leading cause of cancer-related death,” said senior study auhor Dr. Michael Steinberg, director of clinical affairs at the UCLA Health Jonsson Comprehensive Cancer Center.

“The integration of adaptive radiation with chemotherapy offers a novel approach that shows promise in terms of safety, effectiveness and improved patient outcomes, paving the way for more effective and personalized treatments." Steinberg said.

More information

Find out more about the treatment of lung cancer at the American Cancer Society.

SOURCE: University of California, Los Angeles, news release, Jan. 10, 2024