Advanced Radiation Therapy for Lung Cancer

Current Clinical Trials for Lung Cancer

Clinical Trial for Brain Metastasis from Lung Cancer

Advanced Technologies For Lung Cancer


Stanford Clinical Trials of Radiation Therapy in Lung Cancer

Stanford is advancing the treatment of lung cancer by conducting clinical trials, which can often be the best option for cancer care for patients. Descriptions of ongoing clinical trials at Stanford of radiation therapy in lung cancer may be found below.

For more information, or to learn how to participate in a clinical trial for lung cancer, please contact our clinical trials coordinator:

Leslie Modlin
Clinical Research Assistant
Department of Radiation Oncology, Stanford University
lmodlin at stanford.edu [lmodlin]
(Tel) 650-723-8843

Dr. Billy W. Loo, Jr., M.D., Ph.D.
Assistant Professor and Thoracic Radiation Oncology Program Leader

Brief Descriptions of Current Clinical Trials

  1. A prospective evaluation of outcomes of radiosurgical treatment of early stage non-small cell lung cancer (for patients who cannot have surgery)
    When non-small cell lung cancer is diagnosed in early stages, the standard treatment is surgical resection of the lobe of the lung containing the tumor (lobectomy) and removal of lymph nodes in the region, with good cure rates. However, many patients have significant additional health problems (such as lung disease and heart disease) that make it unsafe for them to have the standard surgical treatment. Radiosurgery, the use of highly focused and intensive radiation therapy, is emerging as a treatment option for these patients. Early results from clinical trials have been promising. The purpose of this study is to determine the short and long term results of radiosurgery for patients with early lung cancer who are unable to have surgery because of other medical problems. This study is designed for patients with stage I or II lung cancer, with a single tumor no greater than 5 cm in size.

  2. Stereotactic body radiation therapy in treating patients with stage I or stage II non-small cell lung cancer that can be removed by surgery (RTOG 0618)
    When non-small cell lung cancer is diagnosed in early stages, the standard treatment is surgical resection of the lobe of the lung containing the tumor (lobectomy) and removal of lymph nodes in the region, with good cure rates. Surgery performed by experienced thoracic surgeons is quite safe overall. Even so, it is an invasive treatment that has the potential for significant side effects. It is reasonable to investigate less invasive alternatives to surgery that promise to be effective. For patients who are unable to have surgery safely because of other medical problems, radiosurgery, the use of highly focused and intensive radiation therapy, is emerging as a treatment. Because early results from clinical trials for such patients have been promising, we are now studying whether radiosurgery may be effective even for patients who are able to have surgery. The purpose of this study is to determine the effectiveness of radiosurgery, or stereotactic body radiation therapy (SBRT), for patients with early stage lung cancer who are able to have surgery but wish to seek an alternative to surgery. This study is designed for patients with stage I or II lung cancer, with a single tumor no greater than 5 cm in size, and not located too close to the major airways and blood vessels in the center of the chest.

    Click here for detailed protocol description, or contact the clinical trials coordinator for more information.

  3. High-dose or standard-dose radiation therapy and chemotherapy with or without a biological inhibitor in treating patients with newly diagnosed stage III non-small cell lung cancer (RTOG 0617)
    When non-small cell lung cancer is diagnosed in stage III (tumor confined to the lung and lymph nodes in the chest), the standard treatment has been a combination of chemotherapy and radiation therapy. The best results have been achieved when chemotherapy is given at the same time as radiation therapy. However, there is still much room for improvement in the cure rates of stage III lung cancer. The advances in radiation therapy technology are making it possible to increase the radiation dose that is given to treat lung cancer. Clinical trials have shown that a higher than standard radiation doses can be given with acceptable safety together with chemotherapy. Another potential way to improve the results of treatment is to add new drug therapies to radiation and chemotherapy. Biological inhibitors like cetuximab may delay or prevent tumor growth by blocking certain cellular chemical pathways that lead to tumor development, and clinical trials have shown that it is possible to give cetuximab together with radiation and chemotherapy with acceptable safety. It is not yet known whether high-dose radiation therapy results in better cure rates than standard-dose radiation therapy, or whether adding cetuximab results in better cure rates than chemotherapy and radiation without cetuximab. The purpose of this study is to compare the effectiveness of high-dose and standard-dose radiation therapy with chemotherapy, with or without cetuximab. This study is designed for patients with stage III non-small cell lung cancer who will have chemotherapy and radiation therapy and who meet certain eligibility criteria.

    Click here for detailed protocol description, or contact the clinical trials coordinator for more information.

  4. Three different radiation therapy regimens in treating patients with limited-stage small cell lung cancer receiving cisplatin and etoposide (CALGB 30610/RTOG 0538)
    Standard treatment for limited stage small cell lung cancer (tumor confined to the lung and lymph nodes in the chest) is a combination of chemotherapy and radiation therapy given together. Clinical studies have shown that giving radiation therapy on a faster schedule is more effective than giving it on a slower schedule. Clinical studies have also shown that it is possible to give higher than standard radiation doses with acceptable safety when delivered with chemotherapy, but it has not been established whether this improves the cure rates for small cell lung cancer. The purpose of this study is to compare the effectiveness of standard accelerated radiation and two other higher dose radiation regimens, given with chemotherapy. This study is designed for patients with limited stage small cell lung cancer.

State of the Art 4-D Image Guided Radiation Therapy / Radiosurgery

Recent years have seen dramatic advances in our ability to “see” lung cancer and whether it has spread to lymph nodes or other organs using advanced scanning technology. This helps us to design radiation treatment plans that target all of the tumor accurately. There have been great improvements in our ability to deliver focused, highly precise, and intense radiation therapy that is shaped to the tumor and avoids normal organs. Imaging technology is used at the time of treatment to ensure that highly complex radiation treatments are delivered precisely and accurately. We have also learned much about how to combine radiation and drug therapies as well as surgery to improve treatment outcomes. At Stanford, we have both developed and pioneered the use of many of these technologies for treating lung cancer, and are constantly advancing the state of the art. In addition, we are conducting clinical trials to evaluate whether these improved technologies lead to better survival in lung cancer.

Advanced technologies that we use for treating lung cancer are:

  1. High resolution CT: CT scanning has been the fundamental tool for identifying the location of lung tumors and making a model of the body for computer based radiation treatment planning. We employ high resolution CT and intravenous contrast whenever possible to produce the best possible images for designing our radiation plans.
  2. PET-CT: PET scanning has revolutionized the treatment of lung cancer by more accurately identifying the extent of spread of lung cancer, allowing us to target small tumor deposits that might not be seen by CT alone. We perform PET scans using the same scanner that is used for the treatment planning CT. This provides much better tumor targeting accuracy than using different scanners for PET and treatment planning.
  3. 4-D CT and 4-D PET: When treating lung cancer, it is important to understand how tumors and normal organs move during breathing. 4-D CT scanning allows us to record a CT “movie” of tumor and organ motion during breathing so we can design radiation treatments that reduce unnecessary radiation to normal organs. We now have the capability of recording 4-D PET as well for the most accurate tumor targeting.
  4. Respiratory gating and dynamic tumor tracking: we have both the capability of triggering the radiation beam on during a specific portion of the breathing cycle, effectively “freezing” the tumor motion (respiratory gating), as well as technology to track the tumor with the radiation beam continuously (tumor tracking) in order to provide the most focused radiation treatment of moving tumors.
  5. Image guidance: we use imaging technologies during radiation treatment to ensure highly accurate patient positioning and delivery of radiation, unlike older systems that rely on invasive frames to immobilize patients for accurate treatment.
  6. Stereotactic radiosurgery: we have developed and use state of the art systems for delivering highly focused radiation therapy for early lung cancer and small lung tumors, including the CyberKnife and Trilogy stereotactic radiosurgery systems, capable of dynamic robotic tumor tracking and high-dose rate dynamic conformal arc radiosurgery.
  7. Most importantly, we have an expert team of physicians, physicists, dosimetrists, therapists, and nurses that not only use this sophisticated technology but have helped to advance the state of the art in radiation treatment of lung cancer.

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