Why Chemoradiation Is the MVP of Stage III Lung Cancer Treatment
If you’ve been diagnosed with lung cancer, you know that hearing the news is totally overwhelming. You also know that after the initial shock wears off, the desire to beat it is like nothing else. While it might not feel like there’s a ton you can control on your cancer journey, you can help stack the deck in your favor. The ideal way to do that? Get the best treatment for your type and stage of lung cancer.
There are more treatment options available than in decades past, one of which is chemoradiation therapy (CRT), which is slightly different than just traditional chemotherapy treatment. Keep reading to learn more about this treatment option, and how it works.
What is CRT?
In decades past, if a patient had inoperable Stage III lung cancer, the standard first-line treatment would be radiation therapy. As time went on, other treatments such as chemotherapy were added to the radiation therapy.
However, now the standard first line of treatment for patients with Stage III non-small cell lung cancer (NSCLC) that cannot be surgically removed is concurrent CRT (cCRT), explains Victoria Villaflor, M.D., a medical oncologist at Northwestern University. Patients undergoing cCRT are treated with “curative intent,” which means the aim is to cure their cancer rather than just delay the advancement of their disease.
According to Dr. Villaflor, CRT is the combination of chemotherapy and radiation, each of which uses different methods to destroy cancer cells. There are two types: sequential CRT (sCRT) and concurrent CRT (cCRT). Patients who receive sCRT receive chemo and radiation one after the other. A patient who receives cCRT receives chemotherapy and radiation at the same time.
The latter treatment approach is considered to be the most effective. “Clinical research demonstrates the combination of radiation and chemotherapy at the same time results in higher overall survival rates,” Dr. Villaflor says.
How long does it take to receive both chemotherapy and radiation?
The length of treatment will vary from person to person and will depend on how well you respond and any potential side effects, according to Dr. Villaflor.
Chemotherapy
Chemotherapy may be administered as an infusion into the bloodstream, an injection, or by mouth, like pills, capsules, or liquid. [1] Chemotherapy works by damaging the DNA of cancer cells, helping to slow or prevent the formation and spread of new cancer cells, Dr. Villaflor says.
Radiation therapy
Unlike chemotherapy, which may also damage healthy cells throughout the body, radiation therapy works by pinpointing and destroying cancer cells. However, it’s important to note that radiation therapy may also damage healthy cells that are in the path of the radiation beam, Dr. Villaflor explains.
Who can receive CRT?
cCRT is currently the standard of care for Stage III NSCLC patients whose cancer cannot be removed with surgery, Dr. Villaflor tells us. For your doctor to determine if it’s right for you, your cancer must be staged correctly. Ensuring you have an accurate diagnosis requires comprehensive input from a multidisciplinary care team. Not only might this include medical and radiation oncologists, but also thoracic surgeons, pulmonologists, and pathologists who are on the front lines of diagnosing patients with Stage III NSCLC.
Substages of Stage III NSCLC
Once staging is confirmed, your healthcare provider will review your health and lifestyle history to determine if cCRT is an appropriate treatment and if you are eligible to be treated with curative intent.
He or she may also ask you several questions about your health history, your current medications, and what tests you’ve undergone, adds Victoria Sherry, C.R.N.P., a nurse practitioner at Abramson Cancer Center at Penn Medicine.
“A lot of patients are concerned with the start of a treatment journey, but it’s also critical to create a plan that will navigate any logistical challenges, such as getting to the doctor’s office and paying for medication,” Sherry says. “These issues have the potential to delay or defer treatment, which will yield poorer results than if a patient receives the full course of treatment concurrently.”
Potential side effects of CRT
“The side effects of CRT can vary based on the type and amount of chemotherapy, the length of treatment, and how the patient’s body reacts to it,” Dr. Villaflor says. The most common side effects are:
Esophagitis (inflammation of esophagus tissue, which causes pain when swallowing)
Pneumonitis (inflammation of lungs caused by disease, infection, radiation therapy, allergy, or irritation of lung tissue by inhaled substances)
Fatigue
Increased risk of infections
Nausea and/or vomiting
Difficulty swallowing
Loss of appetite and weight loss
Skin irritation
Hair loss
Thankfully, the ability to manage side effects of treatment have improved tremendously in recent years, Sherry says. Many are predictable and can be controlled through a variety of interventions, and healthcare teams now can tailor CRT regimens to make people more comfortable throughout treatment. However, if you experience any side effects that bother you or will not go away, definitely consult with your healthcare provider.
How is CRT different from other cancer treatments?
Today, standard of care first line treatment for inoperable Stage III NSCLC is cCRT. cCRT offers patients the potential for treatment with curative intent. “Based on the tumor type and stage, the best approach [as determined by the patient and their healthcare team] is attempted first, with follow-up therapies initiated based on how the cancer responds,” Dr. Villaflor says. “Many inoperable Stage III non-small cell lung cancer patients who complete cCRT might also be eligible for further treatment options, such as immunotherapy, after cCRT.”[2]
Talk to your doctor and check out ArtOfCRT.com if you'd like to learn more about cCRT. It’s important to remember that unlike Stage IV NSCLC, Stage III can be treated with the intent to cure, or achieve remission, even if it is inoperable, Dr. Villaflor says.
SOURCES
[1] https://www.mayoclinic.org/tests-procedures/chemotherapy/about/pac-20385033
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