Real-World Impact of SABR on Stage I Non-Small-Cell Lung Cancer Outcomes at a Scottish Cancer Centre

Abstract

Introduction: Stereotactic ablative body radiotherapy (SABR) offers patients with stage I non-small-cell lung cancer (NSCLC) a safe, effective radical therapy option. The impact of introducing SABR at a Scottish regional cancer centre was studied. Methods: The Edinburgh Cancer Centre Lung Cancer Database was assessed. Treatment patterns and outcomes were compared across treatment groups (no radical therapy (NRT), conventional radical radiotherapy (CRRT), SABR and surgery) and across three time periods reflecting the availability of SABR (A, January 2012/2013 (pre-SABR); B, 2014/2016 (introduction of SABR); C, 2017/2019, (SABR established)). Results: 1143 patients with stage I NSCLC were identified. Treatment was NRT in 361 (32%), CRRT in 182 (16%), SABR in 132 (12%) and surgery in 468 (41%) patients. Age, performance status, and comorbidities correlated with treatment choice. The median survival increased from 32.5 months in time period A to 38.8 months in period B to 48.8 months in time period C. The greatest improvement in survival was seen in patients treated with surgery between time periods A and C (HR 0.69 (95%CI 0.56–0.86), p < 0.001). The proportion of patients receiving a radical therapy rose between time periods A and C in younger (age ≤ 65, 65–74 and 75–84 years), fitter (PS 0 and 1), and less comorbid patients (CCI 0 and 1–2), but fell in other patient groups. Conclusions: The introduction and establishment of SABR for stage I NSCLC has improved survival outcomes in Southeast Scotland. Increasing SABR utilisation appears to have enhanced the selection of surgical patients and increased the proportion of patients receiving a radical therapy.

Prognostic Biomarkers of Systemic Inflammation in Non-Small Cell Lung Cancer: A Narrative Review of Challenges and Opportunities

“…In patients with stage III disease, cytotoxic chemotherapy can supplement radiotherapy (i.e., concurrent chemoradiotherapy), and adjuvant therapies, following chemoradiotherapy or surgery, may improve survival outcomes [6]. However, many patients are not suitable for or decline radical therapy [7,8]. For patients with metastatic disease systemic anticancer therapies (SACT) may be used palliatively, with the aim of controlling cancer burden and improving quality of life and survival [9,10].…”

A traffic light approach for treatment and supportive care stratification in lung cancer

“…Lung cancer remains the leading cause of cancer death worldwide, although there are grounds for optimism, with treatment advances, even for those with advanced disease, leading to improved long-term survival [1][2][3][4][5]. However, treatment is increasing in length, complexity and intensity.…”