Lung cancer treatment treatment is individualized based on the type and size of the cancer, its location and the patient's overall health. Lung cancer has two major sub-types: small-cell and non-small-cell lung cancer. Both types are frequently treated with radiation therapy, which is often combined with chemotherapy.
Non-small-cell lung cancer patients are first evaluated for surgical resection. Depending on the stage of the non-small-lung cancer, radiation therapy may be indicated before surgery to decrease the size of a tumor and make it surgically resectable. In other cases, radiation therapy is used after surgery to eradicate any cancer cells that might remain in the area after surgical bed.
Small primary and metastatic lung tumors can be treated with radiation therapy alone using stereotactic body radiotherapy (SBRT). Such precisely focused high dose radiation therapy of small lung cancers is as effective as surgical removal of the tumors. Radiation therapy can offer the chance for a cure for those patients who are unable to have surgery due to age, location of a tumor or other medical conditions.
We use the OMNI-V stereotactic table to comfortably position the patient for the treatment. To account for the tumor movement due to the patient's normal breathing cycle, the treatment planning starts with 4-D CT simulation. The radiation oncologist then uses this "movie-CT" to outline the tumor as it moves during the breathin cycle and to outline also the normal organs on the moving CT images. Then the treatment volumes are determined to account for the positional and shape changes of tumor and organs due normal breathing. This minimizes the risk of radiation effects on normal tissue.
For very small lung tumors for better target localization, a radiosurgical marker clip can be placed by the pulmonologist before starting the focused radiosurgical teratments.
Before the actual radiation treatment is delivered, the tumor's exact location is again established using "On board Imaging", CT image obtained with the treatment machine itself just before delivering the radiosurgicel treatment. It is first analyzed by the radiation oncologist who adjusts the treatment parameters before each radiosurgical treatment fraction to achieve sub-milimeter accuracy.
Respiratory Gating is another technique available to reduce the effect of tumor motion during treatment delivery. The radiation beam is started and stopped after synchronization with the patient's breathing motion if clinically indicated.
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