Critical Review of Nonsurgical Treatment Options for Stage I Non-Small Cell Lung Cancer

Haasbeek, Cornelis J.A.; Senan, Suresh; Smit, Egbert F.; Paul, Marinus A.; Slotman, Ben J.; Lagerwaard, Frank J.

doi:10.1634/theoncologist.2007-0195

Cited by 49 publications

(22 citation statements)

References 102 publications

(92 reference statements)

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“…Our results in 15 patients demonstrate that SRT can be considered a curative option with minimal toxicity in such high-risk patients, and SRT rapidly is becoming available in many centers worldwide. This is supported by the available literature from patients with medically inoperable, primary stage I NSCLC without prior pneumonectomy, indicating that the local control rate after SRT (>85%) is comparable to that reported after lobectomy 10 with very low morbidity.…”

Section: Discussionsupporting

confidence: 78%

“…In recent years, stereotactic radiation therapy (SRT) has become available as a good treatment alternative for medically inoperable patients with stage I lung cancer. 10 Excellent local control exceeding 85% can be obtained using SRT with low toxicity. 11,12 SRT is a form of highprecision radiotherapy and is characterized by 1) verification of patient positioning before and during treatment; 2) measures to account for tumor motion; 3) multiple (8)(9)(10)(11)(12) radiation beams from different angles; 4) the use of dose distributions that tightly cover the tumor with rapid dose falloff in surrounding normal tissues to reduce toxicity; and 5) most important, the use of extremely high biologic doses of radiation delivered in a few fractions, usually between 3 and 8, within a 2-week period.…”

mentioning

confidence: 99%

“…10 Excellent local control exceeding 85% can be obtained using SRT with low toxicity. 11,12 SRT is a form of highprecision radiotherapy and is characterized by 1) verification of patient positioning before and during treatment; 2) measures to account for tumor motion; 3) multiple (8)(9)(10)(11)(12) radiation beams from different angles; 4) the use of dose distributions that tightly cover the tumor with rapid dose falloff in surrounding normal tissues to reduce toxicity; and 5) most important, the use of extremely high biologic doses of radiation delivered in a few fractions, usually between 3 and 8, within a 2-week period. 13 The largest series of SRT treatment in stage I lung cancer were reported from Japan, 14,15 Scandinavia, 16 the United States, 17 and the Netherlands, 11 comprising experience in over 750 patients.…”

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confidence: 99%

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Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy

Haasbeek

Lagerwaard

Jaeger

et al. 2009

Cancer

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BACKGROUND:Resection of second primary lung tumors that arise after previous pneumonectomy is associated with a high risk of complications. In this study, the authors reviewed outcomes after stereotactic radiation therapy (SRT) for such patients.METHODS:SRT was undergone by 15 patients who developed a new clinical stage I lung cancer at a median of 8.9 years postpneumonectomy, half of whom had severe chronic obstructive pulmonary disorder (COPD). SRT target volumes encompassed all respiratory motion using 4‐dimensional computed tomography (CT) scans, and risk‐adapted radiation schemes that ranged from 3 × 20 grays (Gy) to 8 × 7.5 Gy were used, depending on tumor size, location, and overlap with prior radiation treatment. All schemes had a biologic effective dose >100 Gy. Follow‐up CT scans were obtained at 3 months, 6 months, and 12 months after SRT and yearly thereafter.RESULTS:At a median follow‐up of 16.5 months, no local failures were observed, and only 2 patients experienced grade ≥3 toxicity. One patient had transient pneumonitis that required steroids, and another patient required an increase in oxygen use. The 1‐year actuarial disease‐free survival rate was 92%. One patient died 10 months post‐SRT after developing regional and distant metastases, and 1 patient developed an isolated regional failure. All other patients remained alive and disease free.CONCLUSIONS:SRT was a safe and effective treatment for stage I lung tumors that arose after prior pneumonectomy, even in patients who had severe COPD. SRT was tolerated well, and the current findings suggest that surveillance for second tumors is indicated in all patients after pneumonectomy. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionsupporting

confidence: 78%

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confidence: 99%

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confidence: 99%

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Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy

Haasbeek

Lagerwaard

Jaeger

et al. 2009

Cancer

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“…The advantage of the SABR technique has been demonstrated for early-stage lung cancer patients, who are unfit for radical surgery, with improved local control and diseasespecific survival compared with conventional radiotherapy [6][7][8] and reported rates of serious toxicity ($Grade 3) below 5% [9]. Despite a lack of phase III trial evidence, SABR has now become an internationally established treatment for early lung cancer based on several centres reporting large case series with consistent outcomes [10].…”

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confidence: 99%

Stereotactic ablative radiotherapy in the UK: current status and developments

Jain¹,

Baker²,

Distefano³

et al. 2013

BJR

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Stereotactic ablative radiotherapy (SABR) has developed from the principles and techniques used in the stereotactic radiosurgery treatment of brain metastases. Advances in computer technology, imaging, planning and treatment delivery and evidence from retrospective analysis of single-and multi-institutional early-phase studies have established SABR in the treatment of medically inoperable early lung cancer. Effective multidisciplinary team working is crucial to safe delivery of SABR. The variation in patient selection, radiotherapy planning and delivery techniques has led to a collective approach to SABR implementation across the UK. Centres developing the technique are represented in the UK SABR Consortium, which is supported by the relevant UK professional bodies and represents a platform to develop extracranial SABR across the UK. The uptake of SABR in the UK has been slowed by workforce issues, but at least 15 centres are currently delivering treatment with over 500 patients treated using UK SABR Consortium guidance. A mentoring program is being piloted helping new centres to develop their programs, and over 30 UK centres are expected to be offering SABR treatment by the end of 2014. The use of consistent guidance for patient selection, treatment planning and delivery in the UK gives the opportunity to collect and audit toxicity and outcome across the centres, contributing to the internationally reported SABR experience. Having established this service in the UK, the development of SABR through clinical research is a priority, and with input from the Radiotherapy Trials Quality Assurance Group, the UK is developing a national study program that includes participation in international trials.

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“…Lung Cancer SABR because salvage surgery or mediastinal radiation therapy may be possible options in cases of local or regional recurrence [34]. Given the extreme radiation doses administered, normal organ toxicity is a major concern and much data on this have recently emerged in the literature.…”

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confidence: 99%

Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time?

Das¹,

Abdelmaksoud

Loo

et al. 2010

Curr. Treat. Options in Oncol.

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Surgery is the standard of care for early stage non-small cell lung cancer (NSCLC), with lobectomy being the most oncologically sound resection. Medically inoperable patients and high-risk surgical candidates require effective alternatives to surgery; even operable patients may opt for less invasive options if they are proven to achieve similar outcomes to surgery. Minimally invasive local treatment modalities including dose-intensified conformal radiation therapy, most notably stereotactic ablative radiotherapy (SABR; also known as stereotactic body radiation therapy), and thermal ablation methods such as radiofrequency ablation (RFA) and microwave ablation (MWA) are emerging as promising treatment options whose roles in the treatment of early stage lung cancer are being defined. Early clinical experience and a rapidly growing body of prospective clinical trials, primarily in medically inoperable patients, are demonstrating encouraging effectiveness and safety outcomes in some cases approaching historical results with surgery. Given the very poor prognosis of the medically inoperable patient population, these alternatives to surgery, particularly SABR, are starting to be considered appropriate first-line therapy in properly selected patients, and prospective cooperative group trials to evaluate and optimize RFA and SABR in specific patient subsets are being conducted. For operable patients, prospective multi-center and cooperative groups trials of SABR are ongoing or completed, and international randomized trials of SABR vs. surgery have been initiated. Thus, promising alternatives to surgery for early stage NSCLC are ready for prime time evaluation in the setting of clinical trials, and participation in ongoing trials for both operable and medically inoperable patients is strongly encouraged.

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Critical Review of Nonsurgical Treatment Options for Stage I Non-Small Cell Lung Cancer

Cited by 49 publications

References 102 publications

Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy

Outcomes of stereotactic radiotherapy for a new clinical stage I lung cancer arising postpneumonectomy

Stereotactic ablative radiotherapy in the UK: current status and developments

Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time?

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