Lung Cancer and the role of radiotherapy

Question 1

What is the pimary risk factor in lung cancer?

Answer 1

Smoking

Question 2

Name the common symptoms of lung cancer

Answer 2

Persistent cough - 3/4 weeks
SOB
A cough that gets worse
Repeat chest infections
Loss of appetite
Hemoptysis (blood in sputum)
Weight loss
Dyspnoea
Chest pain
Blood clots
Horseness
Finger clubbing
Unexplained fatigue to lack of energy

Question 3

How is lung cancer diagnosed?

Answer 3

Bronchoscopy
CT-guided biopsy
EBUS
Surgical biopsy
PET-CT
Molecular profiling - EGFR, ALK, ROS1, PDL1

Question 4

Name the 2 subtypes of lung cancer

Answer 4

NSCLC - non-small cell lung cancer
SCLC- small cell lung cancer

Question 5

Describe NSCLC

Answer 5

Non small cell lung cncer (85-90%)

Question 6

Describe SCLC

Answer 6

Small cell lung cancer
(10-15%)
aggressive, rapid spread
often treated with chemo/radiotherapy not surgery
usually caused by smoking

Question 7

Describe the limited stage

Answer 7

Can be encompassed by radiotherapy
Optimal treatment is 4 cycles of chemotherapy combined with radiotherapy
Median overall survival is 2 years, 5 years survival 33%

Question 8

Describe the extensive stage

Answer 8

More common presentation
Chemotherapy (carboplatin + etoposide) - approx 10 months due to resistance it often comes back
Chemo-immunotherapy (addition of atezolizumab) approx 12 months
40% risk of brain metastases

Question 9

What is the criteria for NSCLC surgery?

Answer 9

N0/N1 not T4
Good lung function, co-morbidities (smokers)

Question 10

Define neo-adjuvant

Answer 10

Refers to treatment given before the main treatment usually surgery to shrink the tumour or improve the outcome of the primary intervention

Question 11

Name common Neo-adjuvant therapies

Answer 11

Chemotherapy
Radiotherapy
Hormonal therapy
Targeted therapy

Question 12

What is the purpose of Neo-adjuvant therapy?

Answer 12

Reduce the tumour size to make surgery easir or more effective
allow less invasive surgery
Kill micrometases (tiny undetectable cancer cells)
Assess tumour response to treatment

Question 13

Define adjuvant

Answer 13

Given after the primary treatment (usually surgery) to eliminate any remaining cancer cells and reduce the risk of recurrence

Question 14

Name the common types of adjuvant therapy

Answer 14

Chemotherapy
Radiotherapy
Hormonal Therapy
Targeted therapy
Immunotherapy

Question 15

What is the purpose of adjuvant therapy?

Answer 15

Destroy any microscopic disease left behind after surgery
Lower the chance of cancer coming back
Improve long-term survival outcomes

Question 16

Describe adjuvant therapy given for the treatment of NSCLC

Answer 16

🧪 Adjuvant Chemotherapy (Cisplatin + Vinorelbine)
4–5% survival improvement at 5 years

Given within 12 weeks post-surgery

Used if tumor >4 cm or lymph node involvement

Not all patients are fit enough to start or complete it

Question 17

Describe neo-adjuvant therapy given for the treatment of NSCLC

Answer 17

💉 Neo-Adjuvant Chemotherapy + Nivolumab (Immunotherapy)
3 cycles before surgery

Event-free survival: 32 months (vs 21 months with chemo alone)

Complete pathological response: 24% (vs 4%)

More patients became eligible for surgery

No increase in surgical complications

Question 18

Describe adjivant immunotherapy treatment option for NSCLC

Answer 18

For high PD-L1 expressing tumors

57% reduced relapse risk (42 vs 35 months disease-free survival)

Question 19

Describe adjuvant targeted therapy (Osimertinib)

Answer 19

For EGFR-positive NSCLC

Approved for adjuvant use since 2023

Question 20

Define SABR

Answer 20

SABR is a highly precise form of radiation therapy that delivers very high doses of radiation to a well-defined tumor in the body, typically over 1 to 5 treatment sessions.Uses image guidance and motion management to account for breathing and movement

Often used in early-stage lung cancer, liver metastases, adrenal tumors, and spinal lesions

Question 21

What are the advantages of SABR?

Answer 21

Non-invasive
Shorter-treatment course than conventional radiotherapy
Often used when surgery is not an option

Question 22

Define conventional therapy

Answer 22

Cancer treatment that uses high-energy X-rays or particles to kill or damage cancer cells over a series of low-dose treatments.
involves delivering small doses of radiation to the cancer site daily over several weeks (usually 20-35 lesions)
Lower dose per session, but spread over more sessions

Often used for larger tumors or those near sensitive organs

Less precision than SABR, so wider margins are treated to ensure full coverage

Question 23

What are the advantages of conventional therapy?

Answer 23

Well established and widely available
Effective for many cancer types
Can be combined with chemotherapy (chemo radiation)

Question 24

What are the indications for conventional radiotherapy?

Answer 24

Inoperable non-metastatic disease => not fit enough, extensive, lots of lymph node involvement
Invasion or more extensive nodal (N2) involvement

Question 25

Define SCAT and give examples

Answer 25

Is systemic anti-cancer therapy Examples include: Cytotoxic chemotherapy Targeted therapy (TKIs) Immunotherapy (IO) Antibody-Drug Conjugates (ADCs)

Question 26

When is SCAT indicated?

Answer 26

Neo-adjuvant Adjuvant palliative

Question 27

Define oncogenic drivers

Answer 27

Key Characteristics: Rare mutations that drive cancer growth More common in: Younger patients Females Never-smokers or light smokers

Question 28

How do we test oncogenic drivers?

Answer 28

Primarily test adenocarcinomas Next Generation Sequencing (NGS) allows simulataneous testing for multiple oncogenic drivers

Question 29

How do we treat oncogenic drivers?

Answer 29

Often require targeted therapies

Question 30

How are the side effects of immunotherapies managed?

Answer 30

managed with steroids low grade toxicity - oral prednisolone high grade toxicity - IV methylprednisolone