Factors To Consider for Stereotactic Ablative Radiotherapy in Early-stage, Operable NSCLC
Recent studies attempted to improve the risk of recurrence while reducing the risk of adverse effects after SABR by optimizing the regimen.
Stereotactic ablative radiotherapy (SABR) has emerged as a potential alternative to lobectomy for patients with early-stage, operable non-small cell lung cancer (NSCLC), though larger studies are needed and questions remain regarding the optimal regimen.
SABR is the gold standard for treating early-stage, inoperable NSCLC, and has been investigated as an alternative to lobectomy for operable disease. One reason for this is the patient population: “At the time of diagnosis, the median age is 70. We are talking about a disease that happens in senior patients and, no matter how healthy they are, they will have comorbidities,” Joe Y. Chang, MD, PhD, director of the stereotactic radiotherapy program in the department of radiation oncology at The University of Texas MD Anderson Cancer Center in Houston, told Cancer Therapy Advisor.
He noted that “with SABR, patients have minimal severe side effects: we report less than 5% severe toxicities in properly selected patients.” Dr Chang noted that other advantages of SABR include radiation-induced production of tumor antigens that could cause the subsequent activation of cytotoxic T cells, and radiation-induced tumor damage that promotes drug uptake by the tumor.
The advantage of surgical resection is that it is more thorough, because an entire lobe and regional lymph nodes can be removed. The surgical specimen is also helpful for further molecular profiling, and may guide future targeted therapy. According to Dr Chang, “the question is whether the lymph node dissection is diagnostic or therapeutic, and whether we need to remove the whole lobe for a small peripheral lesion. That has remained controversial.”