Lung Cancer
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Advanced Bronchogenic Carcinoma
The primary treatment for stage III bronchogenic carcinoma patients consists of chemotherapy plus radiotherapy, with concurrent chemotherapy-radiotherapy regimens currently offering the longest median survival (8,9). There is also evidence that surgical resection added to the treatment regimen may further increase the disease-free survival, though pending further investigation, this extremely aggressive tri-modality treatment regimen is not considered the standard of care for stage III patients (20).
At this time, there is no specific evidence that CyberKnife® radiosurgery improves the outcome in stage III patients, primarily because its use in this setting has not been well evaluated.
Local failure remains a prominent failure pattern in stage III patients though, and dose escalation sufficient to sterilize all intrathoracic disease in stage III patients remains limited by normal tissue tolerance. As such, one envisions a potential role for CyberKnife® radiosurgery to areas of bulky and/or residual disease in these patients, potentially providing a benefit comparable to surgical resection in stage III patients (20), ideally under the auspices of a clinical trial until its utility in this setting has been proven.
Written by Donald B. Fuller, M.D. – Radiation Oncologist