A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Murray, P.; Franks, K.; Hanna, G.G.

doi:10.1259/bjr.20160732

Cited by 68 publications

(42 citation statements)

References 94 publications

(69 reference statements)

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“…Chest wall pain is a common presenting symptom in these patients, causing significant detriment to quality of life and further underscoring the importance of local control as an important metric in this cohort. Accordingly, the local control in our series was 89% at 1 year, comparable to reported rates in large SBRT series of T1-2N0 lesions not invading the chest wall [22,23]. The need for maximizing local control is balanced with minimizing treatment-related chest wall toxicity, as large SBRT series have shown rates of acute and chronic chest wall pain of approximately 5% and 17%, respectively with chest wall V30 and obesity predicting for both pain and skin toxicity [24].…”

Section: Discussionsupporting

confidence: 79%

Treatment of T3N0 Non-Small Cell Lung Cancer with Chest Wall Invasion Using Stereotactic Body Radiotherapy

Kennedy

Gabani

Nikitas

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Objectives: Chest wall invasion (CWI) is observed in 5% of localized non-small cell lung cancer (NSCLC). The role of stereotactic body radiotherapy (SBRT) in these patients is unknown. We investigate the safety and efficacy of SBRT in patients with T3N0 NSCLC due to CWI. Methods: Patients with T3N0 NSCLC due to CWI were identified using a prospective registry. CWI was defined as radiographic evidence of soft tissue invasion or bony destruction. We excluded patients with recurrent or metastatic disease. All patients were treated with definitive SBRT. Prescribed dose was 50 Gy in 5 fractions for most patients. Kaplan-Meier analysis was used to estimate survival outcomes. Results: We identified 12 patients treated between 2006 and 2017. Median age was 70 (range, 58-85). Median tumor diameter was 3.0 cm (range, 0.9-7.2). Median survival was 12.0 months (range, 2.4-63). At a median follow-up of 8.9 months (range, 2.1-63), 1-year primary tumor control was 89%, involved lobar control was 89%, local-regional control was 82%, distant control was 91%, and survival was 63%. Of the 4 patients with pre-treatment chest wall pain, 3 reported improvement after SBRT. Two patients reported new grade 1-2 chest wall pain. No grade 3+ toxicity was reported, with 1 patient experiencing grade 1 skin toxicity and 3 patients experiencing grade 1-2 radiation pneumonitis. Conclusions: SBRT for CWI NSCLC is safe, with high early tumor control and low treatment-related toxicity. Most patients with pre-treatment chest wall pain experienced relief after SBRT, with no grade 3+ toxicity observed.

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Section: Discussionsupporting

confidence: 79%

Treatment of T3N0 Non-Small Cell Lung Cancer with Chest Wall Invasion Using Stereotactic Body Radiotherapy

Kennedy

Gabani

Nikitas

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…OM‐HNSCC to the lung may be relatively radioresistant, although this is unlikely given the excellent control rates with radiotherapy with or without chemotherapy for local‐regional disease, especially in HPV‐positive patients . Furthermore, some of these lung “metastases” may be second primary non‐small cell lung cancers; however, 2‐year LC following SABR for those patients is also excellent at approximately 90% . The explanation for this poor LC is unclear and should be further evaluated.…”

Section: Discussionmentioning

confidence: 99%

Oligometastatic squamous cell carcinoma of the head and neck treated with stereotactic body ablative radiotherapy: Single‐institution outcomes

et al. 2019

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Purpose/Objectives: We analyzed outcomes after stereotactic ablative body radiotherapy for oligometastatic (1-5 metastatic foci) head-and-neck squamous cell carcinoma (OM-HNSCC). Materials/Methods: We reviewed patients treated between 2012 and 2016. Endpoints included overall survival (OS), distant progression, and treated-metastasis local control (TM-LC). Results: We analyzed 27 patients with 60 primarily metachronous metastases (81.5%). Median follow-up was 1.6 years (0.2-5.2). Median time from diagnosis to treatment was 1.1 years (0.08-8.5). Overall, 44.4% had solitary, 44.4% had 2-3, and 11.1% had >3 metastases; most metastases were in the lung (44 of 60 metastases). Median OS was 1.9 years; at 1 and 2 years, 78% and 43% were alive (14% without disease progression). Median time to progression was 0.5 years. The 1-year and 2-year TM-LC rates were 75% and 57%. Conclusions: OS is encouraging and disease-free survival remains poor; nevertheless, patients with OM-HNSCC may represent a more favorable subset of patients with metastatic HNSCC. K E Y W O R D Shead and neck, metastatic cancer, outcomes, radiation therapy, stereotactic radiotherapy

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“…However, SBRT has a drawback; SBRT is associated with poor control of local pulmonary lesions or multiple metastatic disease, increasing the risk of cancer-specific death. Pneumonitis, dyspnea, and chest pain were most commonly reported adverse events associated with SBRT 15 , usually occurring approximately 4-12 weeks after treatment, in a systematic review 16,17 . The incidence of toxicities induced by SBRT was higher in patients with central lung cancer (close to the airway) than in those with peripheral lung cancer 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Choice of Treatment for Stage IA Non-small Cell Lung Cancer Patients Ineligible for Surgery: Ablation or Stereotactic Body Radiotherapy?

Liang

Xie

et al. 2020

J. Cancer

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To compare the survival outcomes of ablation and stereotactic body radiotherapy (SBRT) in inoperable patients with stage IA non-small cell lung cancer (NSCLC). Patients and Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 6,395 patients with stage IA NSCLC who had complete clinical information from 2004 to 2015. Kaplan-Meier analysis was performed to determine the propensity score based on the clinical characteristics of patients with stage IA NSCLC. Overall survival (OS) was compared between patients with stage IA NSCLC who were treated with ablation and SBRT after adjusting, stratifying, or matching. Results: Kaplan-Meier analysis demonstrated no significant difference in survival curves (log-rank, p>0.05) between the ablation and SBRT groups. Compared with the SBRT group, the hazard ratio (HR) (95% confidence interval [CI]) of OS was 0.930 (0.817-1.058, p=0.269) in the ablation group on univariate analysis. On multivariate analysis, similar effects on OS (HR: 0.974, 95% CI: 0.858-1.105, p=0.680) were seen in patients with stage IA NSCLC in both the groups. Conclusions: This study suggests that survival does not differ significantly between patients with stage IA NSCLC treated with ablation and SBRT. These results will be helpful for patients with stage IA NSCLC who are ineligible for surgery.

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A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Cited by 68 publications

References 94 publications

Treatment of T3N0 Non-Small Cell Lung Cancer with Chest Wall Invasion Using Stereotactic Body Radiotherapy

Treatment of T3N0 Non-Small Cell Lung Cancer with Chest Wall Invasion Using Stereotactic Body Radiotherapy

Oligometastatic squamous cell carcinoma of the head and neck treated with stereotactic body ablative radiotherapy: Single‐institution outcomes

Choice of Treatment for Stage IA Non-small Cell Lung Cancer Patients Ineligible for Surgery: Ablation or Stereotactic Body Radiotherapy?

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