Role of Stereotactic Radiation Therapy in Operable and Inoperable Early-Stage Non-small Cell Lung Cancer

OPINION STATEMENT

Radiation therapy is becoming an increasingly important part of non-small cell lung cancer (NSCLC) management. Approximately 60% of all cancer patients require radiation therapy (RT) as part of their treatment. For lung cancer, this number is even higher, reaching approximately 77% of all patients, from radical to palliative modalities of RT. This percentage may even be underestimated, as it may not account for the more recent use of RT in oligometastatic lung cancer patients. Thus, we can estimate that each year there will be approximately 21,890 new lung cancer patients in the USA requiring RT. These numbers are expected to continue to rise, as lung cancer radiation techniques continue to improve. There is growing interest in determining the best treatment options for early-stage NSCLC patients. There is well-established data showing the benefit of RT for inoperable patients, and more recent encouraging data even in operable patients.

Radiation Therapy in Older Adults With Cancer: A Critical Modality in Geriatric Oncology

Radiation therapy (RT) is a commonly used modality in the treatment of older adults with cancer, and RT represents an attractive oncologic treatment option, providing a noninvasive local therapy with limited systemic side effects. The Journal of Clinical Oncology (JCO) recently published a special series on Geriatric Oncology providing a comprehensive overview of multiple treatment modalities available to older adults with cancer. The purpose of this short review is to highlight the importance of RT in the treatment of older adults and encourage multidisciplinary participation in their care.

American Society of Clinical Oncology 2021 Annual Meeting Highlights for Radiation Oncologists

The annual meeting of the American Society of Clinical Oncology is the largest multidisciplinary oncology-focused conference in the world. With more than 4900 total abstracts in 2021 alone, it is difficult for individuals to evaluate all the results. This article presents a review of 32 selected abstracts across all disease sites, focusing on those of greatest relevance to radiation oncologists.

Clinical Outcomes and Safety Profile in the Treatment of Synchronous Non-Metastatic Lung Tumors with Stereotactic Body Radiotherapy

PURPOSE/OBJECTIVES

Stereotactic body radiotherapy (SBRT) has increasingly been used to treat early-stage primary lung cancers, but its effectiveness and safety in patients with multiple synchronous primary lung tumors (SPLC) is not as well-established. Our aim was to evaluate clinical outcomes, patterns of recurrence, and toxicities for these patients.

METHODS/MATERIALS

We queried an institutional database of patients treated with SBRT for primary lung tumors from 2007 to 2019. Patients with known metastatic disease were excluded. Recurrences were described as new primaries (NP) if they occurred as an isolated pulmonary mass outside the previous PTV.

RESULTS

We analyzed 126 lesions from 60 consecutive patients who received SBRT synchronously to ≥2 lesions for non-metastatic lung cancers. Median total dose per lesion was 50 Gy (range 30-60 Gy), delivered over 3-5 fractions. All but four lesions were treated to a biologically effective dose (BED10) ≥100Gy. The median follow-up time was 47.3 months (IQR 34.1-65.6). Median overall survival (OS) was 46.2 months. Two and 5-year OS for all patients were 70% and 48%, respectively. Median progression-free survival was 26 months (IQR 7.6-32.6), and at the time of data collection 25 patients (42%) had experienced any disease progression. Median time to progression was 36 months: 9 (15%) patients experienced local failure (LF), with 1 and 2-year LF rates of 8% and 13%, respectively. Four patients (7%) experienced regional failure, at 3, 10, 30, and 50 months. Eleven patients (18%) experienced distant failure (DF), with 2-year DF rate of 13%. Thirteen patients (21%) developed NPs, with 2-year NP rate of 15.1%. 14 patients (23%) experienced CTCAE grade ≥2 toxicity, and two patients (3%) experienced CTCAE grade ≥3 toxicity (pneumonitis and hemoptysis).

CONCLUSION

Synchronous SBRT to BED10 ≥100Gy appears safe and effective for selected patients with SPLC.