SBRT for Early Stage Lung Cancer: Outcomes from Biopsy-Proven and Empirically Treated Lesions

Abstract

Summary points• Stereotactic body radiotherapy for early stage non-small-cell lung cancer has become the standard of care for inoperable patients.• Furthermore, empiric treatment of presumed early stage lung cancer without biopsy is increasingly popular, although it is unclear if radiographic and clinical data alone are sufficient to direct management.• We therefore compared the outcomes of 96 biopsy-proven and 100 clinically diagnosed early stage non-small-cell lung cancers treated with stereotactic body radiotherapy.• Empirically treated lesions were smaller (1.6 cm) compared to biopsy-proven ones (2.2 cm) and patients treated empirically had poorer pulmonary function.• The local control and overall survival at 2 years was 94% and 58% for all patients, with no difference between groups and no grade 3 or higher toxicities.• Our study confirms that stereotactic body radiotherapy is a safe and effective treatment for medically inoperable non-small-cell lung cancer.• Oncologic outcomes for empirically treated lesions were similar to the biopsy-proven group, suggesting that modern imaging and clinical history can substitute a tissue diagnosis in a high risk population.Aim: Herein, we compare outcomes in patients treated with lung stereotactic body radiotherapy (SBRT) with and without tissue confirmation. Methods: We reviewed 196 patients that underwent lung SBRT for presumed (100 patients) or proven non-small-cell lung cancer (96 patients) over a 10-year period and compared outcomes. Results: A total of 196 patients with a median age of 76 underwent lung SBRT to a median dose of 48 Gy in four fractions. Median follow up was 17 months. Local control and overall survival at 3 years was 94 and 58% for the entire group. There was no difference in overall survival, local control, regional control or distant control between the cohorts. Conclusion: SBRT is a safe and effective treatment for patients with non-small-cell lung cancer that are medically inoperable with comparable results in empirically treated patients.

Stereotactic Body Radiation Therapy in Early-Stage NSCLC: Historical Review, Contemporary Evidence and Future Implications

“…This subset of 'high-risk' patients often carries comorbidities that not only preclude lobectomy, but even needle biopsy. These patients have been increasingly treated with SBRT empirically (based upon PET/computed tomography [CT] findings), without establishment of a pathological diagnosis [64][65][66]. Overall, the results of retrospective series have been encouraging [64][65][66].…”

Use and Outcomes of SBRT for Early Stage NSCLC Without Pathologic Confirmation in the Veterans Health Care Administration

“…We were unable to obtain results from pulmonary function tests in our cohort of patients; however, prior studies have shown better lung function in patients with Advances in Radiation Oncology: XX 2021 SBRT for NSCLC without pathologic confirmation PC. 17,20,21 Given the higher rate of death due to COPD in our non-PC patients, it is certainly possible that this group had worse lung function, making them higher risk for biopsy procedures. An advantage of the VA registry is that it comes from an integrated health care system in which nearly all patients treated inside and outside the VA are captured.…”

“…[13][14][15][16] Multiple single-institution studies comparing SBRT with and without PC have been reported with percentages of non-PC cases ranging from 29% to 65%. [17][18][19][20][21] This rate appears to be much lower in general practice in the United States, with reported values of 4.5% from the National Cancer Database (NCDB) and 9.2% from the Surveillance, Epidemiology, and End Results (SEER) registries. 22,23 No differences in overall survival (OS) or local control between groups were observed in these studies, whereas the SEER study showed improved cancerspecific survival in the non-PC group.…”

Stereotactic Body Radiation Therapy Versus Fractionated Radiation Therapy for Early-Stage Bronchopulmonary Carcinoid

“…In those instances, radiation offers a reasonable alternative definitive treatment, extrapolating from many years of use of CFRT in NSCLC [21]. Over the past 10–15 years, lung SBRT has emerged as a highly effective and safe alternative to surgery, typically in nonoperable NSCLC patients [8–10,22]. Naturally, the use of SBRT for NSCLC and other lung tumors has sharply expanded over the past 10+ years [9].…”