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resections are associated with less loss of lung function when compared to lobectomy, as a smaller portion of lung is removed. They carry an operative mortality risk of 1.4 percent. Not all small tumors can be removed by sublobar resections. Usually, these are deep in the middle of the lobe. Pneumonectomy: If the entire lung must be taken out by "pneumonectomy", the expected mortality rate is higher (five to eight percent) with the oldest patients being at highest risk. This happens when tumors are very large or are very close to the large blood vessels (pulmonary artery or vein) of the chest or the mainstem bronchi. Mediastinoscopy: A mediastinoscopy is performed through a small incision in the lower neck above the breastbone (sternum) and is used to sample the lymph nodes in the central chest (mediastinum). An alternative to mediastinoscopy is an EBUS. Radiation therapy, or radiotherapy, delivers high-energy x-rays that can destroy rapidly dividing cancer cells or to palliate symptoms or to palliate symptoms. It has many uses in lung cancer: As primary treatment Before surgery to shrink the tumor After surgery to eliminate any cancer cells that remain in the treated area To treat lung cancer that has spread to the brain or other areas of the body or to palliate symptoms Besides attacking the tumor, radiotherapy can help to relieve some of the symptoms the tumor Lung Cancer Treatment Page 2 of 8 Copyright© 2019, RadiologyInfo.org Reviewed: Jul-17-2019 causes such as bleeding. When used as an initial treatment instead of surgery, radiotherapy may be given alone or combined with chemotherapy. Today, many patients who have a small localized lung cancer, but who are not candidates for surgery, are being treated with a radiation treatment technique known as stereotactic body radiation therapy (SBRT). Patients who are poor candidates for surgery include the elderly, patients with chronic heart failure, and patients receiving a blood thinning drug that puts them at risk of surgical bleeding. SBRT involves treatment with a multitude of small, focused radiation beams tracking the lung tumor along with its respiratory movement, typically in three to five treatments. This treatment delivers very high doses of radiation therapy to the lung cancer in patients where surgery is not an option. SBRT is primarily used in the setting of early stage, localized disease. See the SRS and SBRT page for more information on SBRT. Most often, radiation therapy is delivered by the external beam technique, which aims a beam of x-rays directly at the tumor. Treatment is given in a series of sessions, or fractions, usually over six to seven weeks for conventional treatments, and over one to five treatments for patients that can be treated with SBRT. For more detailed information see the External Beam Therapy (EBT) page. Three-dimensional conformal radiation therapy or intensity-modulated radiation therapy (IMRT) are fairly new techniques based on a 3-D image of the tumor taken with CT scanning. This image serves as the target for a high-dose radiation beam that can change in shape and size to match the tumor. This method minimizes radiation exposure of nearby normal lung tissue. See the Intensity-Modulated Radiation Therapy (IMRT) page for more information. In brachytherapy, radiation is delivered directly to the site of disease. This is usually achieved either through a surgical procedure where after resection of the primary tumor radioactive seeds are sutured to the edge of the surgical resection. Also, in the setting of an obstructive tumor within an airway, radiation is delivered to the site of obstruction through a plastic tube that is temporarily inserted into the airway. This may help to relieve severe symptoms but does not cure the cancer. Chemotherapy involves drugs that are toxic to cancer cells. The drugs are usually given by direct injection into a vein or through a catheter placed in a large vein. Often given after surgery to sterilize microscopic disease, chemotherapy also may slow tumor growth and relieve symptoms in patients who cannot have surgery. Newer biologic agents, which may have fewer side effects than traditional chemotherapy and in some instances may be just as effective,
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