Small Cell Lung Cancer (SCLC) is a special type of lung cancer, which accounts for about 15% of all lung cancer cases. This type of lung cancer is challenging to treat because of its rapid growth, early distant metastasis and poor prognosis. Although the treatment of small cell lung cancer mainly depends on chemotherapy and radiotherapy, the role of radiotherapy in different stages of treatment can not be ignored. This article will discuss the scope of application of radiotherapy for small cell lung cancer and the preparation before radiotherapy.
1. Applicable scope
of radiotherapy for small cell lung cancer The treatment of
small cell lung cancer is usually individualized according to its clinical stage and patient’s physical condition. As an important means in the treatment of small cell lung cancer, radiotherapy is suitable for different stages of treatment, including the following aspects:
1. Limited-stage small cell lung cancer (SCLC)
Limited-stage
small cell lung cancer (LSCLC) is defined as a tumor confined to the same lung or area within the thoracic cavity without distant metastasis. Combination chemotherapy and radiotherapy is the standard of care for patients with limited-stage small cell lung cancer. The role of radiotherapy at this stage is mainly reflected in the control of local tumor progression and the improvement of local lesion control rate.
The role of
radiotherapy: Radiotherapy can help eliminate the local residual tumor, slow down the growth of tumor, and reduce the local recurrence rate. In addition, radiotherapy also has a good control effect on lymph node metastasis in the thoracic cavity.
• Timing of treatment: Patients with limited-stage small cell lung cancer usually begin radiotherapy 2-4 weeks after receiving chemotherapy. Radiotherapy is usually timed to coincide with or follow chemotherapy in order to maximize the therapeutic effect.
2. Extensive-stage small cell lung cancer (SCLC)
Extensive-stage small cell lung cancer (SCLC) is defined as cancer that has extended beyond the lung, often with distant metastasis. In this case, the main effect of radiotherapy is to relieve symptoms and improve the quality of life. Chemotherapy remains the mainstay of treatment for patients with extensive-stage small cell lung cancer, but radiotherapy is still appropriate in certain settings.
• Effect of radiotherapy: For patients with extensive small cell lung cancer with chest symptoms (such as chest pain, hemoptysis, airway obstruction, etc.) or brain metastases, radiotherapy can effectively relieve symptoms, control local tumor growth, and improve quality of life.
• Radiotherapy for brain metastases: Small cell lung cancer is prone to brain metastases, so brain radiotherapy (such as whole brain radiotherapy, WBRT) is an important treatment strategy for extensive stage small cell lung cancer. WBRT can reduce the symptoms caused by brain metastases and delay the loss of neurological function in patients.
3. Postoperative adjuvant radiotherapy
Adjuvant radiotherapy can further reduce the risk of tumor recurrence in patients with limited-stage small cell lung cancer who have
undergone surgical resection of the tumor if the postoperative pathology results suggest that the margin of the tumor cells is not completely resected or that lymph node metastasis is positive. Radiotherapy can help control the residual small lesions after operation and enhance the curative effect.
4. Palliative radiotherapy
Palliative radiotherapy is often used to reduce pain, compression symptoms, or control organ function
in patients with small cell lung cancer who cannot be treated radically. Palliative radiotherapy is especially suitable for patients with severe pleural effusion, airway obstruction or bone metastasis, which can relieve these symptoms and improve the quality of life of patients.
II. Preparations
before radiotherapy
Radiotherapy treatment is a systematic and refined process, which must be evaluated and prepared in detail to ensure the accuracy and safety of treatment. The following are some routine preparations for patients with small cell lung cancer before radiotherapy:
1. Imaging evaluation
Before
radiotherapy, the tumor and surrounding tissues should be evaluated in detail by imaging examination to determine the size, location, shape of the tumor and whether there is lymph node or distant metastasis. Commonly used imaging modalities include chest CT, PET-CT, and MRI. Through these examinations, the extent and metastasis of the tumor can be accurately located, which provides a basis for the subsequent radiotherapy planning.
2. Posture fixation and simulation positioning
Radiotherapy requires the patient to maintain a specific body position to ensure accurate radiation exposure. Before radiotherapy, simulated positioning will be carried out to determine the position that the patient should maintain during the treatment. Common methods of postural immobilization include the use of customized positioning pads, splints, or headrest devices that ensure that the patient does not shift during treatment. For thoracic radiotherapy, it is also necessary to ensure that the patient’s breathing action is controlled during the treatment to reduce the irradiation of normal tissues around the tumor.
3. Formulation of
radiotherapy plan The formulation of
radiotherapy plan is the core link before radiotherapy. Radiotherapists design the best radiotherapy plan according to the patient’s imaging results, the specific location of the tumor and clinical needs. This includes the arrangement of radiotherapy dose, irradiation mode, irradiation area and other details. Modern radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and stereotactic radiotherapy (SRS), can more precisely concentrate high-dose radiation on the tumor site and reduce the damage to surrounding normal tissues.
4. Patient education and psychological support
Radiation therapy may cause some discomfort, especially in the middle and late stages of treatment. Before radiotherapy, doctors and nurses will explain the process of radiotherapy, possible side effects and how to deal with them in detail. At the same time, the psychological state of patients also needs attention, radiotherapy may make patients feel anxious or fearful, so psychological counseling and support are needed to help patients maintain a positive attitude.
5. Nutritional assessment and support
Radiotherapy may cause discomfort in the oral cavity, esophagus, gastrointestinal tract and other parts, affecting the nutritional intake of patients. Therefore, nutritional assessment and intervention before radiotherapy are very important. Proper nutritional support can help patients improve physical strength, enhance treatment tolerance and reduce the occurrence of side effects.
6. Assess organ function and underlying disease
. Before
radiotherapy, underlying disease such as cardiopulmonary function, liver and kidney function should be evaluated. For those patients with comorbidities, treatment and adjustment may be needed to ensure that radiotherapy can be carried out smoothly and does not aggravate the original disease.
Conclusion
Radiotherapy is a part of the treatment of small cell lung cancer, and its scope of application and therapeutic effect depend on many factors. Through accurate radiotherapy plan, individualized treatment plan and adequate preparation before treatment, the treatment effect can be maximized, the side effects can be reduced, and the quality of life of patients can be improved. With the continuous progress of radiotherapy technology, especially the development of precise radiotherapy and targeted therapy, the status of radiotherapy in the treatment of small cell lung cancer will be further strengthened, bringing more hope for patients to survive.
