Quiz: Radiotherapy for Lung Cancer

Use of radiation therapy in the adjuvant, concurrent, and postoperative setting is a critical component in the care of patients with lung cancer. Take this quiz to see when radiation therapy should be used, with what agents, and in what disease stage.

Question 1

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Answer

C. N2. The National Comprehensive Cancer Network (NCCN) guidelines for non–small-cell lung cancer (NSCLC) note that data from SEER found postoperative radiation therapy to be detrimental for N0 or N1 stage disease; however, in patients with N2 nodal stage that was surgically diagnosed, a survival benefit was found.

Question 2

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Answer

C. Cisplatin/pemetrexed.

Pemetrexed with either cisplatin or carboplatin is recommended in patients with non-squamous NSCLC. The NCCN recommends that carboplatin/paclitaxel, cisplatin/etoposide, and cisplatin/vinblastine be used in concurrent chemoradiation regimens for all histologies.

Question 3

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Answer

A. 5%. The optimal timing of thoracic radiation therapy relative to chemotherapy has been thoroughly evaluated, according to the National Cancer Institute’s treatment guide on SCLC, noting that data suggest a small benefit to early thoracic radiation therapy.

Question 4

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A. Significantly decreased symptomatic brain metastases. A total of 4.6% of patients treated with prophylactic cranial irradiation had symptomatic brain metastases, compared with 29.7% in the observation arm (P < .00001), according to the study. Median overall survival was 24.2 months in the prophylactic cranial irradiation arm and 21.9 months in the observation arm (P = .52). At 3 months, global quality of life was worse in the prophylactic cranial irradiation arm (P = .02), “but not afterwards,” the authors noted.

Question 5

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Answer

C. N2 disease. Adjuvant radiation therapy is not recommended for patients with resected stage I or II disease or as routine use in those with stage IIIA N2 disease. “However, a postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks of adjuvant radiation therapy for each patient with N2 disease,” the guideline stated.