The Role of Radiotherapy in the Treatment of Lung Cancer: A Review of Therapeutic Methods and Effects
DOI:
https://doi.org/10.12775/JEHS.2025.78.57687Keywords
Lung cancer, Radiotherapy, Non-small cell lung cancer, Small cell lung cancerAbstract
Introduction
Lung cancer is a leading cause of cancer-related deaths worldwide, with rising cases and mortality. In 2022, there were 2.48 million new cases and 1.8 million deaths globally. The primary risk factor is tobacco smoking, though genetic factors, pollution, and other exposures also contribute. Lung cancer is divided into Non-Small Cell Lung Cancer (NSCLC), which includes adenocarcinoma, squamous cell carcinoma, large-cell carcinoma; and Small Cell Lung Cancer (SCLC), characterized by rapid growth, early metastatic spread and greater chemosensitivity in comparison to NSCLC. Treatment depends on the cancer type and stage, with surgery and radiotherapy being treatment of choice for NSCLC and chemoradiotherapy for SCLC.
Materials and methods
This article is the result of the review of the scientific literature available in PubMed database using keywords: “Lung Cancer”, “Radiotherapy”, “Non-Small Cell Lung Cancer”; “Small Cell Lung Cancer”
Aim of study
The aim of the study is to summarize available knowledge about various methods of treatment of lung cancer by means of radiation therapy and its diverse techniques. The epidemiology, etiology, staging and methods of treatment were summarized and described. Modern radiotherapy techniques for treating lung cancer have also been included.
Conclusions
For NSCLC, modern techniques like stereotactic radiotherapy (SBRT/SABR) provide surgical-level effectiveness in early stages with reduced toxicity, while concurrent chemoradiotherapy is optimal for inoperable stage III disease. Palliative radiotherapy remains vital for symptom relief in advanced stages. For SCLC, concurrent chemoradiotherapy is the standard for limited-stage disease, while prophylactic cranial irradiation (PCI) and thoracic radiotherapy improve survival in extensive-stage cases responding to chemotherapy.
References
1. Cancer. World Health Organization. Updated February 3, 2022. Accessed January 2, 2025. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer.
2. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. https://doi.org/10.3322/caac.21660
3. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. https://doi.org/10.3322/caac.21834
4. Didkowska JA, Wojciechowska U, Barańska K, et al. Cancer in Poland in 2021. Warszawa. Polish National Cancer Registry. 2023. ISSN 0867-8251.
5. Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Respir J. 2016;48(3):889-902.
https://doi.org/10.1183/13993003.00359-2016
6. Nooreldeen R, Bach H. Current and Future Development in Lung Cancer Diagnosis. Int J Mol Sci. 2021;22(16):8661. Published 2021 Aug 12.
https://doi.org/10.3390/ijms22168661
7. Kalemkerian GP. Advances in the treatment of small-cell lung cancer. Semin Respir Crit Care Med. 2011;32(1):94-101. https://doi.org/10.1055/s-0031-1272873
8. Govindan R, Page N, Morgensztern D, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24(28):4539-4544. https://doi.org/10.1200/JCO.2005.04.4859
9. Tanoue LT. Lung Cancer Staging. Clin Chest Med. 2020;41(2):161-174. https://doi.org/10.1016/j.ccm.2020.02.006
10. Allen C, Her S, Jaffray DA. Radiotherapy for Cancer: Present and Future. Adv Drug Deliv Rev. 2017;109:1-2. https://doi.org/10.1016/j.addr.2017.01.004
11. Minniti G, Goldsmith C, Brada M. Radiotherapy. Handb Clin Neurol. 2012;104:215-228. https://doi.org/10.1016/B978-0-444-52138-5.00016-5
12. Jassem J, Kordek R. Oncology. Textbook for students and physicians. 5th ed. Gdańsk. Grupa Via Medica. 2019. ISBN 9788366145986.
13. Guckenberger M, Andratschke N, Alheit H, et al. Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol. 2014;190(1):26-33.
https://doi.org/10.1007/s00066-013-0450-y
14. Giraud P, Morvan E, Claude L, et al. Respiratory gating techniques for optimization of lung cancer radiotherapy. J Thorac Oncol. 2011;6(12):2058-2068. https://doi.org/10.1097/JTO.0b013e3182307ec2
15. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines [published correction appears in Cancer. 2006 Aug 1;107(3):660]. Cancer. 2005;104(6):1129-1137. https://doi.org/10.1002/cncr.21324
16. Delaney GP, Barton MB. Evidence-based estimates of the demand for radiotherapy. Clin Oncol (R Coll Radiol). 2015;27(2):70-76. https://doi.org/10.1016/j.clon.2014.10.005
17. Lim E, Baldwin D, Beckles M, et al. British Thoracic Society, Society for Cardiothoracic Surgery in Great Britain and Ireland. Guidelines on the radical management of patients with lung cancer. Thorax. 2010; 65 Suppl 3: iii1–ii27. https://doi.org/10.1136/thx.2010.145938
18. Krzakowski M, Jassem J, Antczak A, et al. Thoracic neoplasms. Oncol Clin Pract 2022;18(1):1-39. https://doi.org/10.5603/OCP.2021.0022
19. Louie AV, Palma DA, Dahele M, et al. Management of early-stage non-small cell lung cancer using stereotactic ablative radiotherapy: controversies, insights, and changing horizons. Radiother Oncol. 2015; 114(2): 138–147.
https://doi.org/10.1016/j.radonc.2014.11.036
20. Zhang Q, Shao L, Tian J, et al. Stereotactic body radiation therapy or surgery for stage I-II non-small cell lung cancer treatment?-outcomes of a meta-analysis. Transl Cancer Res. 2019;8(4):1381-1394. https://doi.org/10.21037/tcr.2019.07.41
21. Nyman J, Hallqvist A, Lund JÅ, et al. SPACE - A randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLC. Radiother Oncol. 2016;121(1):1-8. https://doi.org/10.1016/j.radonc.2016.08.015
22. Ball D, Mai GT, Vinod S, et al. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial. Lancet Oncol. 2019;20(4):494-503. https://doi.org/10.1016/S1470-2045(18)30896-9
23. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group. Lancet. 1998;352(9124):257-263.
https://doi.org/10.1016/S0140-6736(98)06341-7
24. Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl_4):iv1-iv21.
https://doi.org/10.1093/annonc/mdx222
25. Nikolaos P, Vasilios L, Efstratios K, et al. Therapeutic modalities for Pancoast tumors. J Thorac Dis. 2014;6 Suppl 1(Suppl 1):S180-S193.
https://doi.org/10.3978/j.issn.2072-1439.2013.12.31
26. Eberhardt WE, De Ruysscher D, Weder W, et al. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol. 2015;26(8):1573-1588. https://doi.org/10.1093/annonc/mdv187
27. Furuse K, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol. 1999;17(9):2692-2699. https://doi.org/10.1200/JCO.1999.17.9.2692
28. Vinod SK, Simonella L, Goldsbury D, Delaney GP, Armstrong B, O'Connell DL. Underutilization of radiotherapy for lung cancer in New South Wales, Australia. Cancer. 2010;116(3):686-694. https://doi.org/10.1002/cncr.24762
29. Nawrocki S, Krzakowski M, Wasilewska-Tesluk E, et al. Concurrent chemotherapy and short course radiotherapy in patients with stage IIIA to IIIB non-small cell lung cancer not eligible for radical treatment: results of a randomized phase II study. J Thorac Oncol. 2010;5(8):1255-1262. https://doi.org/10.1097/JTO.0b013e3181e15d33
30. Guckenberger M, Lievens Y, Bouma AB, et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020;21(1):e18-e28.
https://doi.org/10.1016/S1470-2045(19)30718-1
31. Gomez DR, Blumenschein GR Jr, Lee JJ, et al. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol. 2016;17(12):1672-1682. https://doi.org/10.1016/S1470-2045(16)30532-0
32. Skowronek J. Brachytherapy in the treatment of lung cancer - a valuable solution. J Contemp Brachytherapy. 2015;7(4):297-311. https://doi.org/10.5114/jcb.2015.54038
33. Cardona AF, Reveiz L, Ospina EG, Ospina V, Yepes A. Palliative endobronchial brachytherapy for non-small cell lung cancer. Cochrane Database Syst Rev. 2008;(2):CD004284. Published 2008 Apr 16.
https://doi.org/10.1002/14651858.CD004284.pub2
34. De Ruysscher D, Pijls-Johannesma M, Bentzen SM, et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol. 2006;24(7):1057-1063. https://doi.org/10.1200/JCO.2005.02.9793
35. Fried DB, Morris DE, Poole C, et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer [published correction appears in J Clin Oncol. 2005 Jan 1;23(1):248]. J Clin Oncol. 2004;22(23):4837-4845. https://doi.org/10.1200/JCO.2004.01.178
36. Aupérin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 1999;341(7):476-484. https://doi.org/10.1056/NEJM199908123410703
37. Wolfson AH, Bae K, Komaki R, et al. Primary analysis of a phase II randomized trial Radiation Therapy Oncology Group (RTOG) 0212: impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;81(1):77-84. https://doi.org/10.1016/j.ijrobp.2010.05.013
38. Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007;357(7):664-672. https://doi.org/10.1056/NEJMoa071780
39. Slotman BJ, van Tinteren H, Praag JO, et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial [published correction appears in Lancet. 2015 Jan 3;385(9962):28]. Lancet. 2015;385(9962):36-42. https://doi.org/10.1016/S0140-6736(14)61085-0
40. Glatzer M, Schmid S, Radovic M, Früh M, Putora PM. The role of radiation therapy in the management of small cell lung cancer. Breathe (Sheff). 2017;13(4):e87-e94. https://doi.org/10.1183/20734735.009617
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