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Lynne Eldridge MD

Radiation Pneumonitis in Stage 3 Lung Cancer

By September 19, 2012

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Unfortunately, the slang phrase "slash, poison, burn," bares a hint of reality in describing the side effects of cancer treatment. Treatment isn't without side effects -- and they are sometimes as dreaded as cancer itself. Just as chemotherapy is well-known for the "poison" side effects of hair loss and nausea, radiation therapy is known for its "burns." And for people with lung cancer, the tissue that is "burned" is often the lungs.

Radiation pneumonitis, while not a true burn, can be painful. It stands literally for "lung inflammation" and can feel (I've been told) like a burn in your chest.

As a very commonly used treatment for stage 3 lung cancer, researchers set out to see how frequently radiation therapy causes radiation pneumonitis. They selected a group of patients who were treated with radiation therapy plus or minus chemotherapy as a definitive treatment for lung cancer. If the patients in the study had symptoms of radiation pneumonitis, they were then ranked on a severity scale from 1 to 4, with 1 being mild, and 4 being most severe.

Overall, 51% of people in this study developed radiation pneumonitis. Looking at the range of symptoms:

  • 20% of patients had grade 1 pneumonitis
  • 18% had grade 2
  • 8% had grade 3
  • 4% had grade 4

Who is most at risk? There didn't seem to be much that allowed doctors to make that prediction, other than the timing of chemotherapy used with radiation therapy. Radiation pneumonitis was not more common in older patients, in one sex than another, in people who smoked, or in people with other medical conditions. It was more common, however, in people who had chemotherapy at the same time as radiation therapy, something called "concurrent" therapy.

Shouldn't this now mean that maybe people should be treated with chemotherapy and radiation therapy at separate times (called sequential therapy?) After all, the risk of radiation pneumonitis was significantly lower. The answer brings up an important point about weighing the risks of benefits of treatments for cancer. Yes, concurrent therapy results in a higher risk of this disturbing side effect, but there are other factors to consider.

A 2009 study found that people with stage 3 lung cancer treated with concurrent chemotherapy and radiation therapy had double the survival rate at 5 years of those who received sequential (one at a time) therapy. A 2011 study found similar survival results, but also noted an increased risk of esophagitis (inflammation of the esophagus) in people who received the 2 treatments together.

Clearly the timing of radiation therapy and chemotherapy with stage 3 lung cancer is something your want to think about carefully, and discuss the risks and benefits with your oncologist. I'm sure many of you will have an opinion after reading this, but the choice is very personal (and there are additional factors I didn't address here.) One person may want to do anything that might increase survival chances regardless of possible side effects. Of note, is that radiation pneumonitis is treatable and many people recover without any problems. Another person may, in contrast, wish to opt for a shorter survival rate in exchange for a lower likelihood of side effects - and hence - a better quality of life. Neither approach is "right." What is right is making the best decision for you as a person with all of the information possible to make that decision.

Further Reading:

Source:

Kim, M. et al. Factors predicting radiation pneumonitis in locally advanced non-small cell lung cancer. Radiation Oncology Journal. 2011. 29(3)181-90.

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