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Non-Small Cell Lung Cancer

In order to choose the optimal treatment, it is important to receive comprehensive and comprehensible information. If radiotherapy has been recommended to you, ask your treating oncologist about all the available irradiation methods as well as treatment-related side effects. These may significantly affect the quality of your life during and after treatment. Our physicians have many years of experience in radiotherapy. Moreover, they are experienced in both standard (photon) and proton radiation therapy and are prepared to answer all of your questions.

The treatment for Non-small cell lung cancer (NSCLC) depends on the extent of the disease, the general condition of the patient, and further diseases.

One substantial reason to choose proton radiotherapy for lung cancer would be radiation induced heart disease (RIHD). Heart disease caused by radiation is one of the most serious and best-documented very late effects of radiation. Therefore, in the treatment of lung cancer, when radiation is recommended, experts seek to minimise the radiation dose to the heart. Thanks to the proton beam, we are able to significantly reduce the risk of the occurrence of cardiac infarction, cardiac complaints, or the risk of development of pulmonary fibrosis.

Indications for Proton Radiotherapy

  • St. I, IIA – T1-2N0M0, inoperable due to comorbidities or due to refusing of operation
  • St IIB, IIIA – locally advanced tumours (T1-4 N1), non-resectable
  • St IIIB – T1-4, N2 – locally advanced tumours (T1-4 N1), non-resectable

Contraindications

  • Stage N3, T4 (multiple tumours)
  • One or more severe comorbidities (each situation is evaluated individually)
  • Metal/ceramic parts in the radiation field
  • Presence of a pacemaker

Advantages of Proton Therapy

  • The overall radiation dose can be increased while guaranteeing lower toxicity to critical organs.
  • Significant dose reduction of undesirable radiation to the healthy tissue of the lungs, reducing the risk of emergence of respiratory complaints and the development of pulmonary fibrosis.
  • Significant dose reduction of undesirable radiation to the cardiac muscle thereby reducing the risk of heart disease.
  • Lower risk of developing swallowing difficulties or loss of appetite.

In early carcinoma, proton therapy enables us to irradiate the target volume with fewer fields (in comparison with conventional photon IMRT), and decrease the integral dose. Decreasing the integral dose is associated with a lower risk of stochastic effects, i.e. lower risk of development of radiation pneumonitis, oesophagitis and secondary tumours. Furthermore, the dose to critical tissues decreases, primarily to pulmonary tissue.

In locally advanced lung carcinoma, proton therapy enables us to accelerate (shorten) the total irradiation time, use a lower number of treatment fractions (hypofractionation), decrease the total dose while maintaining or decreasing the toxicity (lower load of unwanted radiation to critical organs) in comparison with conventional photon radiotherapy. Therefore, proton therapy provides a higher quality of life to patients.

By reducing radiation exposure to surrounding healthy tissues, the dose of radiation to the tumour can be increased when using proton beam radiation, increasing the chance of a cure.

Results with Proton Therapy

It has been demonstrated in patients with non-small cell lung cancer (NSCLC) that dose escalation improves local control and survival. Thanks to the physical properties of protons (Bragg peak), minimisation of the output dose occurs, leading to the sparing of critically important tissues such as the heart, esophagus, airways, major vessels, and the spinal cord in comparison with photon radiation therapy.

The reduction of toxicity in proton radiotherapy leads to a reduced cost in the treatment of side effects, thereby reducing the cost of patient hospitalisation. Dose optimisation also makes it possible to spare healthy tissue in patients with complicated anatomical situations.

Patients whose tumour position changes due to respiratory movements are irradiated using a controlled breathing method called Deep Inspiration Breath Hold (DIBH). This allows us to irradiate the tumour consistently during each treatment session, ensuring safety and precision. Click here to learn how this breathing method works.

To learn more about proton therapy for lung cancer, or to find out if you are a suitable candidate for treatment at our centre, contact us today. Our team will get back to you with a detailed response as soon as possible.