Stereotactic body radiation therapy in stage I inoperable lung cancer: from palliative to curative options

Abstract

Surgery has historically been the standard of care for operable stage I non-small cell lung cancer (NSCLC). However, nearly one-quarter of patients with stage I NSCLC will not undergo surgery because of medical comorbidity or other factors. Stereotactic ablative radiotherapy (SABR) is the new standard of care for these patients. SABR offers high local tumour control rates rivalling the historical results of surgery and is generally well tolerated by patients with both peripheral and centrally located tumours. This article reviews the history of SABR for stage I NSCLC, summarises the currently available data on efficacy and toxicity, and describes some of the currently controversial aspects of this treatment.

Radiofrequency Ablation Using a Multiple-Electrode Switching System for Lung Tumors with 2.0–5.0-cm Maximum Diameter: Phase II Clinical Study

“…In 26 patients without uncontrolled extrapulmonary tumors, the 1-, 2-, and 3-year survival rates were 84.1%, 79.2%, and 66.0%, respectively. Those values were comparable with survival rates after conventional RFA, stereotactic body radiation therapy, and surgical intervention (1)(2)(3)(4)(5)(6)(7)(8)(9)(29)(30)(31).…”

“…Many studies have shown the clinical usefulness of RFA in controlling both primary and metastatic lung tumors (1-6). However, local tumor control after lung RFA is not satisfactory compared with other therapeutic modalities, such as pulmonary resection and stereotactic body radiation therapy (7)(8)(9). Moreover, the ability of local control in the lung with RFA greatly depends on tumor size.…”

A multi‐institutional study to assess adherence to lung stereotactic body radiotherapy planning goals

“…For particular tumor sites, increased conformality leads to a significant decrease in late adverse effects to healthy tissue and therefore improved quality of life for the patient. 7 The conformality index (CI) is a tool used to apply a score to a particular treatment plan in order to delineate a plan with the most conformal isodose. 8 Serious, though uncommon, toxicities of SBRT include such conditions as radiation pneumonitis (RP), bronchial stenosis or necrosis, esophageal injury, brachial plexopathy, chest wall pain, and rib fracture.…”

The dosimetric impacts of gated radiation therapy and 4D dose calculation in lung cancer patients

“…The second is to minimize the collateral damage done to healthy lung structures. This is achieved through a rapid dose falloff gradient, reducing the dose received by surrounding tissues [3,24]. Like IMRT, SBRT uses a multileaf collimator for intensity modulation.…”