How high-precision radiation therapy helped a surfer beat lung cancer

When Paul Hendrix, 65, was diagnosed with early-stage lung cancer in 2023, he knew exactly where to turn. A longtime UCLA Health patient and alumnus of UCLA’s School of Theater, Film and Television, Hendrix had previously beaten throat cancer with the help of UCLA physicians.

This time, he was diagnosed with EGFR-positive lung adenocarcinoma, a form of non-small cell lung cancer that carries a mutation in the epidermal growth factor receptor (EGFR) gene. As molecular testing has become more common, EGFR-positive tumors are being detected more frequently, especially in early-stage cases.

For this type of cancer, surgery is traditionally seen as the preferred standard of care. The recommended treatment for Hendrix was a lobectomy, which involves removing part of his lung. But for Hendrix, an avid surfer, the prospect of losing lung capacity was daunting.

“I’m a lifelong, world-traveling surfer,” Hendrix said. “Losing lung capacity would have permanently changed who I am. I wanted the least invasive treatment that could still give me the best chance at a cure while preserving my full lung capacity.”   

Hoping to avoid surgery, he asked his care team about a newer and more precise form of radiation therapy called stereotactic body radiation therapy, or SBRT, a treatment he was familiar with from his earlier battle with throat cancer.

Stereotactic body radiation therapy: A noninvase alternative with precise delivery of radiation

UCLA’s department of radiation oncology is a global leader in image-guided radiation therapy that allows physicians to see tumors with remarkable clarity so that treatments accurately treat the tumor and avoid normal tissues. That level of accuracy is especially important when treating small tumors located in organs that shift with breathing movements, such as the lungs. This precision helps ensure that radiation doesn’t miss the target and safely spares healthy tissue.

Unlike traditional surgery, SBRT is a noninvasive outpatient procedure that delivers high-dose radiation to small, well-defined tumors with millimeter precision. Treatments are typically completed in just one to five sessions, and many patients report no significant side effects. 

Hendrix was referred to Dr. Drew Moghanaki, chief of thoracic oncology in UCLA’s department of radiation oncology and a researcher at the UCLA Health Jonsson Comprehensive Cancer Center. A nationally recognized leader in lung cancer care, Moghanaki specializes in advanced radiation therapy techniques and is advancing the use of image-guided SBRT for patients who wish to avoid surgery. He serves as principal investigator for the largest clinical trial evaluating SBRT as an alternative for patients, like Hendrix, with early-stage lung cancer. 

“Patients often don’t believe that a non-surgical treatment can cure cancer. Yet we’ve known for more than 30 years that SBRT might provide a similar cure rate as surgery,” Moghanaki said. “Multiple scientific publications have demonstrated no measurable differences in cancer control when patients are treated with surgery or SBRT.” 

UCLA is also leading efforts to bring clarity to the decision-making process. As one of the primary investigators of a national Department of Veterans Affairs clinical trial known as VALOR, Dr. Moghanaki and colleagues are comparing outcomes in patients treated with surgery versus SBRT. With nearly 500 patients enrolled so far in this phase III randomized clinical trial, there are no early signals indicating whether surgery or SBRT improves survival.

After a careful review by a multidisciplinary team at UCLA, Hendrix was given the green light to proceed with SBRT.

For Hendrix, it was reassuring to know that a full team of experts, including radiation oncologists, pulmonologists, surgeons, and medical oncologists, had reviewed his case before recommending a treatment plan.

“That gave me a lot of confidence,” he said. “I felt like I was in the best possible hands.”

Returning to the waves

Courtesy of Paul Hendrix

The treatment was brief and uneventful, Hendrix said. He completed three outpatient sessions, each lasting less than 10 minutes. He did not experience any major side effects, and did not develop a cough or shortness of breath. 

“It felt like going in for a regular scan,” he said. “I didn’t miss a beat.”

Within days, Hendrix was back on his motorcycle. A few weeks later, he was back in the water surfing again.

“I was quite amazed at how easy the recovery was,” he said. “I’m just grateful to be able to surf and to breathe easy. That’s everything to me. And if there’s a lesson here, it’s to get early preventative lung screenings.” 

While surgery remains the standard of care for many people with early-stage lung cancer, Moghanaki said the field is evolving toward a more personalized approach, one that focuses on selecting the most appropriate treatment for each individual.

“Lung cancer care is complex, and the best outcomes come from care delivered by a multidisciplinary team,” he said. “The best treatment isn’t always SBRT, but when it is, a coordinated, team-based approach ensures patients receive the most effective and safest care possible with this wonderful non-surgical option.”