Use of Stereotactic Ablative Radiotherapy (SABR) in Non–Small Cell Lung Cancer Measuring More Than 5 cm

Tekatli, H.; Hof, S. Van 't; Nossent, Esther J.; Dahele, Max; Verbakel, Wilko F.A.R.; Slotman, Ben J.; Senan, Suresh

doi:10.1016/j.jtho.2017.02.021

Cited by 40 publications

(22 citation statements)

References 36 publications

(49 reference statements)

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“…First, critical nearby normal tissue dose constraints such as esophagus, bronchial tree, brachial plexus, heart, major vessels etc. may limit the ablative dose that could be safely delivered (8); second, the efficacy of SBRT is reduced and toxicity is increased with increasing size of the lesion, particularly when the lesion is >5 cm (9). Most of SBRT's outstanding clinical outcomes reported in the literature are based on lesions less than 5 cm, typically <3 cm, and are not close/next to critical normal structures.…”

Section: Rt-treatment For Local Controlmentioning

confidence: 99%

Combining radiation plus immunotherapy to improve systemic immune response

et al. 2018

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Over the past decade, the fields of oncology have made great strides in therapies. The development of new therapeutics and increased understanding of the role of the immune system in the development and treatment of cancer has led to increased collaboration between oncologic fields. Recent technologic advancements in radiation therapy (RT), including stereotactic beam radiation therapy (SBRT), have improved local control and offer an alternative to surgery for the control of oligometastatic disease. Immunotherapy has proven a promising therapeutic in the treatment of metastatic disease but treatment resistance remains a significant obstacle in the majority of patients. Together, radiation and immunotherapy offer potential to eliminate metastatic disease, reduce time to recurrence and improve overall survival. Major obstacles to these positive outcomes include high tumor burden, intratumoral heterogeneity, and the negative effects of tumor stroma, to name a few. Multimodality treatments are under heavy investigation. Promising data from clinical trials is emerging to highlight the value of RT in combination with immunotherapy. However, the mechanisms behind their synergistic effects remain to be fully elucidated. This review aims to highlight the existing literature and offers hypotheses to explain mechanisms behind the synergy of RT and immunotherapy.

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Section: Rt-treatment For Local Controlmentioning

confidence: 99%

Combining radiation plus immunotherapy to improve systemic immune response

et al. 2018

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“…Die Erfahrungen der SBRT beruhen überwiegend auf Tumoren mit einem Durchmesser < 5 cm: Bei größeren Tumoren kommt es zu einer vermehrten Normalgewebsbelastung mit assoziiertem erhöhtem Nebenwirkungsrisiko. In einigen retrospektiven Arbei-ten zur SBRT bei primären Lungentumoren mit einem Durchmesser > 5 cm wurden vielversprechende onkologische Ergebnisse beschrieben und auch die Toxizität erscheint akzeptabel, in einzelnen Arbeiten aber erhöht im Vergleich zur Bestrahlung kleinerer Tumoren [51][52][53].…”

Section: Risikosituationen Für Sbrtunclassified

Stereotaktische Strahlentherapie bei Lungenkrebs im Stadium I – gibt es eine Evidenz?

Gückenberger¹

2017

Zentralbl Chir

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Stereotactic body radiotherapy (SBRT) was first described in the mid 90s as a technique using high precision radiotherapy to deliver escalated, ablative irradiation doses and which simultaneously minimised incidental irradiation of healthy tissue. Technological and clinical development of this technique has been pioneered in the field of early stage non-small cell lung cancer, where improved local tumor control led to prolonged overall survival. Today, SBRT is the evidence-based and guideline-recommended treatment of choice for early stage NSCLC in patients who are medically inoperable. SBRT has been demonstrated to be a safe and effective curative treatment option, even for very elderly patients and patients with severe comorbidities. Only patients with very short survival expectancy should not be offered SBRT. Increasing evidence suggests that the outcome is similar or equivalent for surgical lobectomy and SBRT in operable patients; however, SBRT is currently only recommended for patients refusing surgical resection. Many clinical trials are currently evaluating the value of SBRT in clinical settings other than early stage NSCLC, e.g. oligometastases and oligoprogression.

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“…A report on outcomes of SABR in tumors exceeding 5 cm suggested that high local control rates and acceptable survival outcomes were achieved in patients without coexisting interstitial lung disease. 24 In patients with lung cancer and coexisting interstitial lung disease who underwent SABR, a systematic review reported a weighted proportion of treatment-related deaths of 15.6%. 25 In the 2017 American Society for Radiation Oncology guidelines, SABR was considered an appropriate option for tumors exceeding 5 cm if physicians endeavored to adhere to the constraints that had been utilized in prospective studies.…”

Section: Introductionmentioning

confidence: 99%