How is early non-small cell lung cancer treated with surgery or SBRT?
Usually, cancers that are limited to a small area of the chest are best treated with a local treatment to remove or kill the entire tumor. Surgery and stereotactic body radiation therapy (SBRT) also known as stereotactic ablative radiotherapy (SABR) are forms of local treatment. Surgery to remove the cancer may be the best option for early NSCLC, if the tumor is small. Surgery is generally more effective than SBRT in removing all the cancer, but not everyone can safely tolerate surgery, or some individuals may opt for a non-surgical approach.
Surgery
Different operations can be used to treat (and possibly cure) NSCLC. With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer. Surgery will require general anesthesia (where you are in a deep sleep) and are usually done through a large surgical incision between the ribs in the side of the chest or the back (called a thoracotomy). The 4 most commonly used surgeries for early NSCLC are listed in the table below.
The type of surgery you get depends on the size and location of the tumor and on how well your lungs work. If your lungs are healthy, your doctor may do a larger surgery to give the best chance for cure.
When you wake up from surgery, you will have a tube (or tubes) coming out of your chest and attached to a special container to allow excess fluid and air to drain out. The tube(s) will be removed once the fluid drainage and air leak slow down. Generally, you will need to spend 5 to 7 days in the hospital after the surgery.
Non-Surgery Treatments
Other treatment options include radiation and systemic therapy.
Systemic Therapy
Systemic therapy is used alone or in combination with other therapies (for example surgery or radiation) to control your cancer. Types of systemic therapy used in early NSCLC include:
- Chemotherapy – drugs that kill fast growing cells, including cancer cells
- Immunotherapy – drugs that use your own immune system to kill cancer cells
- Targeted therapy – drugs that target changes that are specific to your cancer cells
If you receive systemic therapy and undergo surgery for your early NSCLC, your doctor may use these terms to describe when the systemic therapy is used:
- Neoadjuvant: Systemic therapy (or radiation) given before surgery.
- Adjuvant: Systemic therapy (or radiation) given after surgery.
Radiation
Stereotactic ablative radiotherapy (SABR), is a type of radiation that gives a high dose of radiation to the tumor, but little to your healthy tissues. It is a treatment of choice for small tumors when surgery may not be the best treatment.
SBRT is often given in 1 to 5 treatments. Radiation beams are aimed at the tumor from different angles. To help target the radiation to your tumor, you are put in a body frame for each treatment. This reduces the movement of the lung tumor during breathing and helps make sure the radiation targets your tumor and not your healthy tissues.
