Lung Cancer Radiation Treatment Raising Red Flags: Report

Some doctors are warning that a form of lung cancer radiation therapy can be deadly, even when used correctly. 

According to a case report published last month in the New England Journal of Medicine, a patient who died of central airway necrosis after stereotactic body-radiation therapy (SBRT) highlights what could be an inherent danger associated with the procedure.

The letter’s authors, a group of doctors from the Hospital of the University of Pennsylvania, indicate that even when done correctly, radiation exposure to kill lung cancer can damage healthy tissue.

SBRT uses high levels of radiation against a pinpoint target to treat and control stage 1 non-small-cell lung cancer. However, even with the most precise equipment used correctly, nearby healthy cells are bombarded with radiation.

If the tumors being targeted are near radiation-sensitive parts of the body, like the large airways, heart and spinal cord, there can be an increased risk of radiation injury, the doctors wrote.

The case study involved a 61-year-old woman with lung cancer from smoking. She was treated with SBRT and all indications seem to suggest the surgery was performed accurately and that the responded well with no signs of acute toxicity. Eight months after being treated with SBRT she began suffering the effects of central airway necrosis, including internal bleeding. She died 11 months after the surgery. The researchers believe the central airway tissue was killed by the SBRT, which targeted a nearby tumor.

“This report of fatal central-airway necrosis in a patient treated with SBRT underscores the importance of long-term follow-up of patients with central tumors and the necessity of protocol-based treatment,” the doctors concluded. “Furthermore, it may be prudent to consider post-treatment bronchoscopic surveillance of patients with central tumors to determine the true frequency of tracheolbronchial injury.”

Concerns about the overall impact of radiation on patients, whether from specific treatments or standard imaging techniques, like CT scans and x-rays, have increased in recent years.

According to the findings of another study published earlier last month, the use of imaging scans among Americans has increased substantially over the past 15 years, greatly increasing the number of individuals who are receiving an amount of radiation that is considered high or very high in one year.

In November 2010, the FDA recommended that the radiation therapy industry make changes to equipment and training to lessen the risk of radiation overdose for patients. The recommendations came after a year-long investigation by the FDA, which concluded that nearly all radiation exposure problems suffered by patients are due to operator error and are rarely contributed to by broken CT scanners.