Non small cell lung cancer radiation therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]

Overview

Radiation therapy regimens

Shown below is a list of the different regimens radiation therapy for patients with non-small cell lung cancer. The list of regimens has been adapted from the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]

Usual Dosages for Definitive Radiation Therapy

Administer fractions of 2 Gy over a period of 6 to 7.5 weeks to a total dose of 60 to 74 Gy.

Neoadjuvant Radiation Therapy Regimen

Administer fractions of 1.8 to 2 Gy over a period of 5 weeks to a total dose of 45 to 50 Gy.

Adjuvant Radiation Therapy Regimens

  • Negative surgical piece margins: Administer fractions of 1.8 to 2 Gy over a period of 5 to 6 weeks to a total dose of 40 to 54 Gy.
  • Positive surgical piece margins: Administer fractions of 1.8 to 2 Gy over a period of 6 weeks to a total dose of 54 to 60 Gy.
  • Extracapsular nodal extension: Administer fractions of 1.8 to 2 Gy over a period of 6 weeks to a total dose of 60 to 70 Gy.
  • Residual tumor: Administer fractions of 2 Gy over a period of 6 to 7 weeks to a total dose of 54 to 60 Gy.

Stereotactic Ablative Radiotherapy Usual Dosage

  • Peripheral small tumors: 25 to 34 Gy not fractioned.
  • Peripheral tumors and chest wall tumors larger than 1 cm: 45 to 60 Gy administered in 3 fractions.
  • Central or peripheral tumors smaller than 5 cm: 48 to 60 Gy administered in 4 fractions.
  • Central or peripheral tumors principally chest wall tumors smaller that 1 cm: 50 to 55 Gy administered in 5 fractions.
  • Central tumors: 60 to 70 Gy administered in 8 to 10 fractions.

Whole brain radiation therapy

Whole brain radiation therapy regimens for metastases to the brain are the following Adapted from the 2014 NCCN Central Nervous System Cancers guidelines[2]:

  • 10 fractions of 3 Gy each to a total of 30 Gy.
  • 15 fractions of 2.5 Gy each to a total of 37.5 Gy.
  • 5 fractions of 4 Gy each to a total of 20 Gy. Good option for patients with poor performance status.

Palliative Radiation Therapy Regimens

Listed bellow are the recommended palliative radiation therapy regimens for patients with non-small cell lung cancer according to the 2014 NCCN Non-Small Cell Lung Cancer guidelines[1]

  • Obstructive disease: Administer fractions of 3 Gy over a period of 2 to 3 weeks to a total dose of 30 to 45 Gy.
  • Bone metastases associated with soft tissue mass: Administer fractions of 4 to 3 Gy over a period of 1 to 2 weeks to a total dose of 20 to 30 Gy.
  • Bone metastases not associated with soft tissue mass: Administer fractions of 8 to 3 Gy over a period of 1 to 14 days to a total dose of 8 to 30 Gy.
  • Patients with poor performance status and symptomatic chest disease: Administer fractions of 8.5 Gy over a period of 7 to 14 days to a total dose of 17 Gy.
  • Metastatic disease in patients who have a poor performance status: Administer fractions of 8 to 4 Gy over a period of 1 to 7 days to a total dose of 8 to 20 Gy.

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