Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline

Videtic, Gregory M.M.; Donington, Jessica S.; Giuliani, Meredith; Heinzerling, J.H.; Karas, Tomer Z.; Kelsey, Chris R.; Lally, Brian E.; Latzka, Karen; Lo, Simon S.; Moghanaki, Drew; Movsas, Benjamin; Rimner, Andreas; Roach, Michael C.; Rodrigues, George; Shirvani, Shervin M.; Simone, Charles B.; Timmerman, Robert; Daly, Megan E.

doi:10.1016/j.prro.2017.04.014

Cited by 342 publications

(264 citation statements)

References 17 publications

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“…Stereotactic Body Radiation Therapy (SBRT) is now accepted as a standard of care for medically inoperable early stage non-small cell lung cancer (NSCLC) [1], [2]. Long term results of retrospective series show excellent local control rates but poor survival with higher rates of distant metastasis despite early stage at presentation [3], [4], [5], [6].…”

Section: Introductionmentioning

confidence: 99%

Anemia is a poor prognostic factor for stage I non-small cell lung cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT)

Pathak

Pantarotto

Cook

et al. 2019

Clinical and Translational Radiation Oncology

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HighlightsThis study reports on the prognostic ability of haematological parameters for the largest known biopsy-proven stage-I medically inoperable cohort treated with SBRT.After SBRT, the median values of Hb, ALC, ANC and TPC declined whereas the NLR and the PLR increased as compared to pre-SBRT.Anemia along with other parameters was found to be a poor prognostic factor for local control despite treatment with SBRT to doses of >100 Gy BED10.Simple and minimally invasive methods like a peripheral blood sample can provide prognostic information even for stage-I NSCLC patients.Patient, tumor and treatment factors along with molecular markers should be used to create risk stratification models that can guide therapy.

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Section: Introductionmentioning

confidence: 99%

Anemia is a poor prognostic factor for stage I non-small cell lung cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT)

Pathak

Pantarotto

Cook

et al. 2019

Clinical and Translational Radiation Oncology

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“…Limited and non‐randomized lung SBRT studies without pathologic proof of malignancy report local control rates of > 90% and distant failure rates comparable to those of biopsy‐proven cases treated with SBRT . The 2017 American Society for Radiation Oncology guidelines state with “moderate evidence” that lung SBRT can be delivered without tissue confirmation in select cases, provided that the lesion is radiographically and clinically consistent with malignancy, but without any specific radiographic criteria …”

Section: Introductionmentioning

confidence: 99%

Image‐based management of empiric lung stereotactic body radiotherapy (SBRT) without biopsy: Predictors from a 10‐year single institution experience

et al. 2018

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BackgroundThere is emerging reliance on clinical imaging for the diagnosis, prognosis, and treatment evaluation of early stage non‐small cell lung cancer (NSCLC) in patients deemed too high risk for biopsy. We report our experience of clinically diagnosed NSCLC treated empirically with stereotactic body radiotherapy (SBRT) to validate the imaging parameters used for management in this high‐risk population.MethodsWe reviewed 101 empiric lung SBRT cases and profiled imaging specifics of computed tomography and positron emission tomography for diagnosis and follow‐up. Secondarily, we identified potential correlates of disease progression with Cox regression multivariate analysis.ResultsFifty‐seven men and 43 women aged 45–94 (median 76) were treated with a median dose of 48 Gy in four fractions. The median nodule diameter was 1.6 cm (0.6–4.5 cm) and most were spiculated (n = 58), right‐sided (n = 63), and in the upper lobe (n = 68). Median follow‐up and survival rates were 14 and 28 months, respectively. Local control at three years was 94%. Freedom from any progression at one and three years was 85% and 69%, respectively. Toxicity ≥ grade 3 included two grade 3 dyspneas. A pre‐treatment standard uptake value > 4.1 was the only significant predictor of disease progression.ConclusionThis study illustrates the instrumental role of modern clinical imaging for the effective management of presumed early stage NSCLC treated with empiric lung SBRT. As lung SBRT without tissue confirmation becomes more common, hopefully these assertions can be prospectively validated.

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“…Furthermore, if incidental lymph nodes within the hilum or mediastinum are detected, adjuvant chemotherapy, which is known to improve survival, can be pursued . Recent consensus guidelines from the American Society of Radiation Oncology state that SBRT is not recommended outside a clinical trial for patients with standard operative risk for lobectomy with a systemic mediastinal lymph node evaluation, which is defined as an anticipated operative mortality < 1.5% …”

Section: Recommendationsmentioning

confidence: 99%

Surgery versus stereotactic body radiation therapy for stage I non–small cell lung cancer: A comprehensive review

Tandberg

Tong

Ackerson

et al. 2017

Cancer

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130

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Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death in the United States. With the implementation of lung cancer screening, the number and proportion of patients diagnosed with early-stage disease are anticipated to increase. Surgery is currently the standard of care for patients with operable stage I NSCLC. However, promising outcomes with stereotactic body radiation therapy (SBRT) in patients with inoperable disease has led to interest in directly comparing SBRT and surgery in operable patients. Unfortunately, early randomized trials comparing surgery and SBRT closed early because of poor accrual. In this article, the nuances of surgery and SBRT for early-stage NSCLC are reviewed. Furthermore, retrospective and prospective analyses of SBRT in early-stage NSCLC are discussed, and active randomized trials comparing these 2 approaches are described. Cancer 2018;124:667-78. © 2017 American Cancer Society.

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Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline

Cited by 342 publications

References 17 publications

Anemia is a poor prognostic factor for stage I non-small cell lung cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT)

Anemia is a poor prognostic factor for stage I non-small cell lung cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT)

Image‐based management of empiric lung stereotactic body radiotherapy (SBRT) without biopsy: Predictors from a 10‐year single institution experience

Surgery versus stereotactic body radiation therapy for stage I non–small cell lung cancer: A comprehensive review

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