Radiation Therapy for Lung Cancer | Q&A with Russell Hales, M.D.

Well, radiation is used to treat lung cancer in a variety of settings. I think before we talk about when it’s used, we first have to talk about stage. When we think about cancer, we think about what the stage of the cancer is. Stage is critical because it drives the therapy we give. And somebody with the earliest stage of cancer, a tumor just in the lung itself that hasn’t spread any further, a surgery or radiation can be given to entirely get rid of that cancer. In tumors that are more advanced, say those that have spread to lymph nodes or to other parts of the body, the role of radiation is more limited. It can be used in tumors that have spread to lymph nodes. When tumors spread more distantly, we can use radiation to help with the symptoms. But when a tumor has spread outside of the chest, the backbone of therapy is a therapy that can go all throughout the body.

An example of this would be chemotherapy or immunotherapy. So radiation can actually be used in the earliest stages of cancer, and in more later stages of cancer, with different goals in mind. One of the exciting parts about radiation treatment for our patients is that it marries the best of technology with medicine to help patients have the best chance of a cure, while at the same time minimizing toxicity or side effects. When we specifically think about technology, our radiation treatments are customized for each patient. We have a team of physicists and dosimetrists. These are specialists who help design how to bring in radiation beams. They will help us to identify how to best avoid normal tissues. I like to tell patients that the chest is the Manhattan of the body. The heart, the lungs, the spinal cord, the esophagus, there’s a lot of critical structures there. And so our team of physicists can help us optimize a treatment plan which can avoid these normal tissues, while at the same time, targeting the area of concern, the tumor. We were just talking about technology and about how technology allows us to enhance our ability to bring in radiation beams.

We can now go in and locate normal tissues in the chest, we’re close to the heart, the spinal chord, the lungs, the esophagus. We can locate those structures and also identify targets. We then use super computers to help us plan how to hit the target, that is in this case, the tumor, while at the same time, avoiding these normal structures.

This is why a team of physicists is so critical in our treatment. We can also track how tumors move. In lung cancer, one of the challenges we have is that as a patient breathes in and out, a tumor is moving up and down in the chest. In essence, we’re targeting something that is moving. We can use sophisticated technologies to track how a tumor moves so that we can do a better job of staying off of normal tissues and make the treatment as safe as possible for our patients. When we think about the benefits of any therapy, our goal is always to get the best possible outcome. And when we think about cancer, that goal is cure.

In some situations that is a goal that can be realized. In other situations we’re trying to control a cancer for as long as possible. Radiation treatment helps us to decrease the chance of a tumor ever coming back in the chest, which is normally what we’re targeting. While at the same time, doing this without a surgery, without blades, without an operation. What this means is that we can get the best chance of giving the patient a good outcome in terms of their cancer, while at the same time minimizing toxicity. As is the case with any medical procedure, there are risks to that procedure. Our goal is to minimize those risks.

But I tell patients even in the safest of hands, when everything is going right, there are intrinsic risks in therapy. If we were to list the possible side effects, they could go on for a long time, just as if you read the back of an aspirin bottle, you’d see a lot of potential risks. In reality, the side effects of treatment very much depend on what we’re targeting. If we have a tumor that is in the lung that’s an early stage cancer, and we give radiation to help get rid of that, patients may half fatigue and tiredness during treatment. They may have some scar tissue that forms in the lung around the area we treat. But most patients will not feel more winded or short of breath after treatment. In patients with more advanced tumors where the tumor has spread to lymph nodes in the middle of the chest, we’re also targeting those lymph nodes which sit close to the esophagus.

Treating close to the esophagus can cause some irritation with swallowing during treatment, but that usually gets better after treatment is over. Lung cancer treatment is complex. It involves multiple experts and specialists coming together to make a coordinated decision to help optimize a patient’s path through cancer care. What this means is that a thoracic surgeon, a chemotherapy doctor, a radiation doctor, and many other specialists have to work together for the benefit of the patient. In our multidisciplinary team, patients are able to come in and see a thoracic surgeon, chemotherapy doctor, and a radiation doctor all in one coordinated visit. While this visit occupies the better part of a day, patients are able to come in and see all the doctors and other specialists that they’ll need to to have a successful plan put into place to manage their cancer. When a patient’s diagnosed with cancer, it can feel like the carpet’s been pulled out from under them. And having clarity as to the path forward is critical.

There are three unique things that we bring to the table for our patients here at Johns Hopkins. The first is expert based care. Our team is full of dedicated thoracic oncology experts. What this means is that these are doctors who focus on treating lung cancer. What that means is that a group of experts will be wholly focused on that patient’s care. The second thing we bring is this multi-disciplinary approach. It’s critical that all the doctors caring for the patient are rubbing shoulders and in constant communication about the patient. The third thing we offer is innovation and discovery. We stand on the shoulders of patients from years before. And the technologies that allow us to deliver the therapy we do today come from discovery that happened yesterday.

Our mission is to be on the forefront of that to constantly bring something better for our patients. And we do that through innovation and research, which is a part of our mission. .