LUNG CANCER TREATMENT
STEREOTACTIC RADIOSURGERY
A Bloodless, Non-invasive, Outpatient Treatment for Lung Tumors
Lung cancer is one of the most common cancers in Singapore and is the leading cause of cancer death worldwide.
There are many treatment options for lung cancer depending on factors such as:
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Stage of disease
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Age
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One's fitness for surgery.
Every person's cancer is different so it is important that a thorough assessment is conducted so that treatment can be best personalised to each individual.
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In this modern era, scientific and technological advances have provided new treatments for lung cancer that are minimally invasive, precise, and with less side effects compared to conventional treatments such as chemotherapy and open surgery.
Treatment Options:
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Stereotactic Radiosurgery (non invasive surgery)
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Targeted Therapy (also known as "magic bullet" chemo pills)
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Immunotherapy (to boost our own immunity)
These are such examples that have provided new hope in the fight against both early and late stage lung cancer.
What is Lung Stereotactic Ablative Radiosurgery?
Lung Stereotactic Ablative Radiosurgery (SABR) is a non-invasive, highly targeted form of radiation treatment that is recommended in international cancer guidelines as an alternative to surgery in early stage lung cancers for selected patient groups. SABR has been proven in studies to confer excellent survival rates comparable to surgery and is an increasingly important option in early stage lung cancer treatment.
* The NCCN guidelines on NSCLC is written by 30 leading cancer centres in the U.S and is regarded as the gold standard internationally
Lung SABR is also commonly used in stage 4 cancers to target tumors that have spread to the lung, and to prevent or relief symptoms. Often, it is combined with immunotherapy to achieve a synergistic effect. Unlike surgery or other invasive procedures, SABR does not cause disruption to the continued use of chemotherapy or targeted therapy in these patients.
SABR works by using technologically advanced machines to deliver extremely focused beams carrying high doses of radiation directly to the tumour to destroy it. With SABR, an entire treatment course can be completed in three to five outpatient sessions over two weeks, with no surgical or anaesthetic risk.
Modern Linear Accelerator with 6 degrees of freedom robotic couch
Lung SABR destroys lung cancer with painless and precise radiation beams
What are the risks of surgery?
Surgery for lung cancer is a major operation and can have serious side effects, which is why it isn’t a good idea for everyone.
In general, some of the potential risks and complications of lung cancer surgery may include:
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Reactions to anaesthesia
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Excessive bleeding
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Damage to a lung, blood vessel, nerve or the heart
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Blood clots in the lung or legs
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Rarely, some people may not survive the surgery
Recovering from lung cancer surgery typically takes weeks to months and your activity might be limited for at least a month or two.
Finally, in a proportion of patients, surgery may be incomplete and remnants of the tumour are left behind. In such situations, these patient will still require further radiation, resulting in them having to undergo 2 treatments instead of one.
Understanding the difference between Surgery and Radiosurgery
Before
After
Right-sided lung tumor treated with SABR with complete disappearance of tumor 6 months later
Surgery involves physically cutting through tissue and bone to reach the tumor so as to remove it from the body.
Radiosurgery does not involve any cutting at all. The name was given because after destroying the tumor with high doses of focused radiation, the body automatically removes the dead cells, and the cure rate is as if surgery was done
It is completely painless, bloodless and is done as an outpatient procedure.
Patient does not need to undergo open surgery and does not suffer from operation risks
Using advanced technology, radiosurgery precisely targets tumors painlessly, without the need for open surgery
Is it true that if I have radiotherapy first, surgery will be impossible later?
Moreover, with modern radiotherapy equipment & techniques, radiation oncologists are now able to precisely target the tumour while limiting damage to the surrounding tissues, thus minimizing the risk of complications from subsequent surgery.
It is therefore important to see a sub-specialized radiation oncologist and lung cancer surgeon, who are both confident of managing these situations.
It is not true that having radiation first will make surgery impossible in the future. In fact, in certain lung cancer situations, it is standard protocol to have radiation and/or chemotherapy before surgery, in order to shrink the tumour so it can be completely resected.
Alternative Treatment Options
Radiosurgery
Radiosurgery is a non-invasive treatment using precise and intense beams of radiation to target the cancer. It borrows from the term “surgery” as this treatment is considered a form of “bloodless” surgery, where the tumour is destroyed without the need for an operation and its accompanying risks, in just a few outpatient sessions.
Radiosurgery is an example of how recent technological advances have enabled new treatment options in the treatment of lung cancer. Radiosurgery is now recommended in American and European guidelines as an alternative to surgery in patients with high operative risk, and as an option to be discussed in patients with standard operative risk. Call us today to find out more on Radiosurgery.
Targeted Therapy
In patients unsuitable for surgery or radiosurgery (such as in larger tumours or more advanced cancers), targeted radiotherapy combined with chemotherapy is usually the primary treatment. It is also sometimes used before or after surgery. Such treatments use radiation beams of lesser intensity then radiosurgery and are delivered over a longer period of 6-7 weeks.
Advanced radiotherapy techniques, such as Intensity Modulated Radiotherapy (IMRT), Volumetric Arc Therapy (VMAT) or Proton Beam Therapy (PBT) are used nowadays to deliver targeted radiotherapy. Compared to radiotherapy a few decades ago, these techniques cause fewer side effects and may be more effective.
Immunotherapy
Immunotherapy is one of the newest treatments for lung cancer. Unlike other treatment, it does not attack cancer cells directly but stimulates a person’s immune system to recognise and destroy cells on their own. Such treatments therefore cause fewer side effects and may be more effective.
Chemotherapy
Chemotherapy for lung cancer can be given before surgery (to shrink the tumour), or after surgery (where the risk of recurrence is high). It can also be combined with radiotherapy. In cases where the cancer has spread beyond the lung to other parts, chemotherapy may be the primary treatment.
Our Lung Radiosurgery Specialist
Senior Consultant Radiation Oncologist
MBBS (SIN), FRCR (Clinical Oncology, UK)
FAMS (Radiation Oncology)
Clinical Interest:
Lung Stereotatic Ablative Radiosurgery (SABR)
Lung Cancers & GI, Gynaecology, Brachytherapy
Dr David Tan Boon Harn
View Dr David Tan's profile here
Dr David Tan's publications
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What You Need To Know About Lung Cancer
This Ebook is created to provide cancer patients, caregivers, family and friends a compilation of the relevant resources that they can use to navigate their cancer journey.
Lung Cancer Ebook Content:
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What is Lung Cancer
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Lung Cancer in Women
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Symptoms of Lung Cancer
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Early Stage Symptoms
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Later Stage Symptoms
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Diagnostic Tests for Lung Cancer
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Treatment Options
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Potential Side Effects
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Your First Consultation Toolkit