New considerations in predicting toxicity from partial irradiation of the lung

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Radiation is routinely used in treatment of thoracic tumours. In most cases, radiation is emitted from a source outside a body and has to penetrate through skin and other tissues to reach a tumour inside. Absorption of the energy carried by radiation damages living cells, leading to cell death or preventing further cell divisions. Although modern irradiation techniques are designed to achieve deposition of a maximum of radiation energy in the tumour volume, a certain amount of energy gets absorbed in normal tissues around. This may cause harm and may result in dangerous side effects. Very complicated is treatment of lung cancer. It is the third most common cancer in Europe and the most common cause of cancer death accounting for one fifth of total cancer mortality. Majority of lung cancers is histologically rated as non-small cell lung cancer (NSCLC). For patients whose tumour has grown locally to an extent precluding surgical resection, radiation therapy in conjunction with chemotherapy represents the only hope for a cure. However, the majority of them die within two years of diagnosis. This is because the radiation dose required for NSCLC tumour destruction is very high and devlivery of such dose without damaging surrounding vital organs (lungs, eosophagus, spinal cord and heart) is technically difficult, often impossible.

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