Doctors test radiation for lung cancer

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OUR HEALTH

By DAVID RUMBACH

Tribune Staff Writer

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To find out more about these lung cancer treatment trials, call research nurse coordinator Kathy Tudor at (317) 278-7276.

An Indiana University School of Medicine professor of radiation oncology wants to change the conventional wisdom that surgery is the best choice for treatment of early-stage lung cancer.

Dr. Ronald C. McGarry is conducting two clinical trials designed to determine whether super-high doses of precisely targeted radiation -- both with and without chemotherapy -- can eradicate early-stage lung tumors.

If so, patients might have a reasonable alternative to surgeries that remove large sections of lung.

"I call this a lung-sparing approach to cancer treatment,'' McGarry said.

The two trials of nonsurgical lung cancer treatment are open to patients from Michiana, McGarry said.

They require at least four trips to IU-staffed hospitals in Indianapolis, one for planning and three for treatment.

The need for improved treatment of lung cancer has been highlighted in recent weeks by the death of ABC anchorman Peter Jennings and news that Dana Reeve, widow of actor Christopher Reeve, has been diagnosed with the disease.

Because overall death rates are high, lung cancer is the top cancer killer for both men and women.

The American Cancer Society estimates that 173,000 Americans will be diagnosed with lung cancer this year; an estimated 164,000 will die of it.

But a patient's chances of surviving lung cancer are better than people think when the tumor is caught in the early stage.

From 50 percent to 90 percents of patients whose lung cancer was diagnosed in stage 1 are still alive five years later, McGarry said.

By contrast, only 2 percent of people diagnosed with stage 4 lung cancer survive for five years.

"That's something people don't realize,'' McGarry said. "There is good treatment for early-stage lung cancer.''

Unfortunately, only 20 percent of cancer cases are diagnosed early.

When surgeons operate on early-stage lung cancer, they almost always remove an entire lobe -- about one-third of a lung's volume -- in an effort to remove the localized tumor.

It's currently believed that radiation, alone or with chemotherapy, is not nearly as effective as surgery. But McGarry thinks that may not be true.

In the two trials he's heading at IU, patients are given very high doses of radiation that are precisely targeted to the tumor.

The doses are so high that the course is completed in just three treatments given over seven to 10 days.

McGarry said radiation oncologists in community hospitals give the same amount of radiation overall but spread it over a much longer period -- in 35 treatments over six weeks.

"The difference is that we give huge doses of radiation in a short time,'' he said.

While the doses are huge, McGarry said, they are also concentrated on the target tumor in a way that minimizes damage to surrounding tissue.

Both trials are for lung cancer patients who have other health problems, such as heart failure, that make them poor candidates for lobectomy.

One of the trials is sponsored by the National Cancer Institute; it's a continuation of a trial that began in 2000. Patients receive radiation treatment only.

In the second trial, sponsored by Indianapolis-based drug maker Eli Lilly and Co., patients receive high-dose radiation followed by two cycles of chemotherapy.

The chemotherapy uses a new drug believed to be less toxic than established cancer drugs.

McGarry said he hopes the trials, while reserved for cancer patients who can't have surgery, help prove that radiation can work as well as surgery for early-stage lung cancer.

It's possible that surgery only appears to be better because of what he sees as a bias in the way survival statistics are kept.

When surgeons operate on a patient with lung cancer, they sometimes find that what had appeared to be early-stage disease in scans was actually advanced disease, McGarry said. They are able to reclassify the case, excluding it from the statistics for early-stage outcomes.

But radiation oncologists cannot do that, so the statistics on their treatments of early-stage disease have traditionally included many cases of advanced cancer. Hence, a bias against them in comparison to surgeons.

More recently, however, staging of cancer has become more accurate with the widespread use of PET scanning technology. Oncologists are better able to distinguish early-stage cancer, leveling the playing field for nonsurgical approaches such as radiation or radiation followed by chemotherapy.

Staff writer David Rumbach:

drumbach@sbtinfo.com

(574) 235-6358