Today’s Curb Side Consult: Adding CyberKnife treatments after chemotherapy may help patients with stage IV non-small cell lung cancer
Marge from Kettering, sits down to talk to Dr. Ed Hughes, radiation oncologist, about her lung cancer.
Marge: “I heard a lot of good things about CyberKnife for patients with early stage lung cancers. Only 3-5 visits. No cutting. No pain. Done as an outpatient.
But I have stage IV non-small cell lung cancer. It’s in my left lower lung. I had chemo and the lung cancer shrunk up, but it’s not gone. And I still have a spot on my liver and a spot on my spine. I know that my cancer is bad. But I want to live as long as I can without symptoms. Can CyberKnife help me?”
Dr. Hughes: “That’s a great question, Marge. I now have some answers for you, some real options. And the answer is “possibly.” So what does it depend on? Stage IV non-small cell lung cancer patients who may benefit from CyberKnife include those patients who:
1). Had at least a partial response or even stable disease after chemotherapy.
2). Had only a few sites of metastatic disease, so-called ‘limited metastatic non-small cell lung cancer.’
So Marge, your situation is a quite common one. Up to 70% of stage IV non-small cell lung cancer patients have partial responses or stable disease following first-line chemotherapy. The key is to make those chemo responses last longer. I think real breakthrough progress has been made recently.”
Marge:”So what happens now after my chemo is done? Are there studies to prove that this treatment plan is going to work?”
Dr. Hughes: “A small, but crucial study done by Dr. Iyengar and Associates at the University of Texas Southwestern Medical Center showed that adding stereotactic ablative body radiotherapy (SABR), like that delivered by CyberKnife, extended survival from 3.5 months to 9.7 months. Quite remarkable results.
Importantly, major side effects from SABR, like that delivered by CyberKnife, were well tolerated. In a press release at the September 2016 ASTRO annual meeting, Dr. Iyengar said, “The addition of consolidative radiation did not increase toxicity, which allowed patients to continue onto additional systemic therapy that is important to controlling aggressive metastatic disease.” So with good collaboration between your medical oncology doctor and your radiation oncology doctor, CyberKnife can be given safely and effectively, even with chemotherapy or immunotherapy. Real hope is here.”
Marge: “So now what happens?”
Dr. Hughes: “As it turns out, the Dayton Clinical Oncology Program (DCOP), of which I am a member, does have a clinical trial called NRG-LU002-that “randomizes” the patient to maintenance chemotherapy versus maintenance chemotherapy plus SABR, like that delivered by CyberKnife. Another option is to be treated “off protocol” so that you choose CyberKnife and not leave it up to the “coin flip” of a computer as to whether or not you’ll get CyberKnife treatment. But you have to tell your pulmonologist and your medical oncologist you want it.”
For any questions about your stage IV non-small cell lung cancer, feel free to call me, Dr. Edward Hughes, at 855-Dayton 1. I guarantee that I will see you in consultation within 1-3 days of your phone call.