ASTRO: Lung SBRT, a good alternative to surgery for some
According to a recently released report by the American Society for Radiation Oncology (ASTRO), stereotactic body radiotherapy (SBRT) in the treatment of lung cancer can be a reasonable alternative to surgery in certain cases of the disease.

The report noted that surgical resection of tumors is the traditionally utilized method of treatment for this patient population. However, many lung cancer patients are deemed unfit for surgery due to the presence of other medical conditions, including chronic obstructive pulmonary disease related to habitual smoking that put them at an unacceptably high risk of surgical morbidity and mortality. For this patient cohort, six to seven weeks of radiotherapy treatments have been utilized, but typically result in a high rate of local failure. In addition, many individuals who are surgical candidates refuse surgery.

For these patients, SBRT--a radiation therapy that uses focused radiation beams to target a well-defined tumor and relies on detailed imaging, computerized 3D treatment planning and precise treatment setup to deliver the radiation dose to many parts of the body--is an option, said the report.

Despite SBRT being potentially more effective in tumor killing by delivering few, very large doses of daily radiotherapy from which cells will have limited ability to recover, explained Andre Konski, MD, ASTRO's Emerging Technology Committee chair and chair of radiation oncology at Wayne State University in Detroit, better response rates have been observed with smaller tumors and higher radiation doses, compared to larger tumors.

“Lung SBRT may be an alternative to surgery for small volume, early stage disease if local control proves durable,” said the committee. “An expected increase in tumor response using SBRT for primary non-small carcinomas of the lung is supported radiobiologically.”

“In the operable setting, we conclude more study and longer follow-up is necessary to ensure that results are equivalent to those of surgery. Ideally, medically operable patients with Stage I lung cancer would likely receive SBRT on a structured investigative protocol,” the report said.

"The committee believes that some lung cancer patients will greatly benefit from this treatment as it will shorten their treatment time and improve their quality of life," stated Konski.