Is it time for SABR to overtake surgery as the treatment of choice for stage I non-small cell lung cancer?
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ABSTRACT:
SUBMITTER: Love SM
PROVIDER: S-EPMC5233541 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
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Is it time for SABR to overtake surgery as the treatment of choice for stage I non-small cell lung cancer?
Love Susannah M SM Hardman Gillian G Mashar Ruchir R Shah Rajesh D RD
Annals of translational medicine 20161201 24
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| S-EPMC5418272 | biostudies-literature
Project description:There is debate about what is the optimal treatment for operable stage I non-small cell lung cancer (NSCLC). Although surgery has been the standard of care for centuries, recent retrospective and prospective randomized studies indicated that stereotactic ablative radiotherapy (SABR) could be an option for this group of patients with similar survival and less toxicities. However, to change the standard of care, more studies are needed and participating ongoing larger randomized studies is the best approach to resolve this controversy.
| S-EPMC4858582 | biostudies-literature
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| S-EPMC7212131 | biostudies-literature
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| S-EPMC11833375 | biostudies-literature
Project description:PurposeFive-fraction stereotactic ablative radiotherapy (SABR) regimens are frequently used to treat centrally located early-stage non-small cell lung cancer or disease in the proximity of the chest wall as a means of optimizing tumor control and reducing treatment toxicity. However, increasing these SABR regimens to 5 fractions may reduce tumor control outcomes. We sought to identify the clinical parameters predictive of treatment failures with these 5-fraction courses.MethodsNinety patients with T1-2 non-small cell lung cancer were treated with 50 or 60 Gy in 5 fractions. Failure over time was modeled using cumulative incidences of local, regional, or distant failure, with death as a competing risk. Cox proportional hazards analysis for incidences of failure was performed to control for patient variables.ResultsOf 90 patients, 24 of 53 patients with T1 tumors and 19 of 37 patients with T2 tumors received 50 Gy SABR, and the other 47 patients received 60 Gy. Two-year overall survival and progression-free survival for the whole cohort were 75.8% and 59.3%, respectively. Total SABR dose (50 vs 60 Gy) did not influence survival nor failure rates at 2 and 5 years. Within 2 years of treatment, 7.8% of all patients developed local failure. For all patient and tumor characteristics evaluated, only T stage and pretreatment positron emission tomography standardized uptake values served as predictors of local, regional, and distant failure at 2 and 5 years posttreatment on univariate and multivariable analysis.ConclusionsFive-fraction SABR provides excellent in-field control. T2 and high fluorodeoxyglucose uptake tumors have increased failure rates, suggesting the potential need for adjuvant therapies, which are being assessed in randomized phase 3 trials.
| S-EPMC9486424 | biostudies-literature
Project description:IntroductionStereotactic ablative body radiotherapy (SABR) offers patients with stage I non-small-cell lung cancer (NSCLC) a safe, effective radical therapy option. The impact of introducing SABR at a Scottish regional cancer centre was studied.MethodsThe Edinburgh Cancer Centre Lung Cancer Database was assessed. Treatment patterns and outcomes were compared across treatment groups (no radical therapy (NRT), conventional radical radiotherapy (CRRT), SABR and surgery) and across three time periods reflecting the availability of SABR (A, January 2012/2013 (pre-SABR); B, 2014/2016 (introduction of SABR); C, 2017/2019, (SABR established)).Results1143 patients with stage I NSCLC were identified. Treatment was NRT in 361 (32%), CRRT in 182 (16%), SABR in 132 (12%) and surgery in 468 (41%) patients. Age, performance status, and comorbidities correlated with treatment choice. The median survival increased from 32.5 months in time period A to 38.8 months in period B to 48.8 months in time period C. The greatest improvement in survival was seen in patients treated with surgery between time periods A and C (HR 0.69 (95% CI 0.56-0.86), p < 0.001). The proportion of patients receiving a radical therapy rose between time periods A and C in younger (age ≤ 65, 65-74 and 75-84 years), fitter (PS 0 and 1), and less comorbid patients (CCI 0 and 1-2), but fell in other patient groups.ConclusionsThe introduction and establishment of SABR for stage I NSCLC has improved survival outcomes in Southeast Scotland. Increasing SABR utilisation appears to have enhanced the selection of surgical patients and increased the proportion of patients receiving a radical therapy.
| S-EPMC10000454 | biostudies-literature
Project description:BackgroundDelay in lung cancer treatment is associated with worse survival outcomes. We examined whether there are racial disparities in time from diagnosis to treatment initiation for stage I non-small cell lung cancer (NSCLC) using data from the National Cancer Data Base, which includes approximately 70% of incident cancer patients across the United States.MethodsWe analyzed 119 184 patients diagnosed with stage I NSCLC from 2008 to 2013. Median times (in days) from diagnosis to treatment initiation for external beam radiation (EBRT), stereotactic body radiotherapy (SBRT), and surgery (inclusive of wedge resection, lobectomy, and pneumonectomy) were calculated separately and compared among white vs African American (AA) patients using the Wilcoxon rank-sum test. Multivariable linear regression assessed racial differences in days to treatment while adjusting for sex, age, insurance status, regional income, Charlson-Deyo comorbidity score, region, facility type, and treatment. Statistical tests were two-sided.ResultsAA patients had a statistically significantly longer median time to treatment for all three treatment modalities: EBRT 54 days (AA) vs 48 days (white, P < .001); SBRT 66 days vs 55 days (P < .001); surgery 31 vs 26 days (P < .001). In addition, 34% AA vs 24% white patients (P ≤ .001) had treatment initiation eight or more weeks after diagnosis. In multivariable analysis, AA patients experienced an average 8.2-day delay compared with white patients (P < .001).ConclusionsThese results shed light on one possible mechanism of the observed racial disparity in mortality outcomes in NSCLC. Future studies are needed to determine if interventions to reduce treatment delays can reduce racial disparities in this disease.
| S-EPMC6649763 | biostudies-literature
Project description:BACKGROUND:Patients with N2 stage non-small cell lung cancer have prognostic heterogeneity, and this study attempted to explore the prognostic factors among those patients. METHODS:Patients with N2 stage undergoing radical resection in Department of Thoracic Surgery, West China hospital, Sichuan University between January 2007 and December 2016 were included. Cox proportional hazard regression model was used to explore the prognostic value of clinicopathological features. Survival curves were plotted by Kaplan-Meier method. Subgroup analyses considering the situation of lymph node involvement were performed. RESULTS:In total, 773 patients were included. The median follow-up time was 57.2 months, and the 5-year overall survival rate was 34.8%. Tumor-node-metastasis (TNM) stage, number of involved lymph node stations, skip metastasis, lymphatic or vascular invasion and adjuvant chemotherapy were independent prognostic factors. The patients with stage T1-3 had similar prognosis, while the patients with stage T4 had worse survival. In addition, the patients with single station involvement and skip metastasis had the best prognosis with a 5-years overall survival rate of 48.9%. CONCLUSIONS:T4 stage patients had worse survival in N2 group. To get a more precisely stratification, skip metastasis and number of involved lymph node stations should be considered in future N stage classification.
| S-EPMC7007397 | biostudies-literature
Project description:Volumetric-modulated arc therapy (VMAT) is emerging as a leading technology in treating early-stage, non-small cell lung cancer (NSCLC) with stereotactic ablative radiotherapy (SABR). However, two other modalities capable of deliver-ing intensity-modulated radiation therapy (IMRT) include fixed-beam and helical TomoTherapy (HT). This study aims to provide an extensive dosimetric compari-son among these various IMRT techniques for treating early-stage NSCLC with SABR. Ten early-stage NSCLC patients were retrospectively optimized using three fixed-beam techniques via nine to eleven beams (high and low modulation step-and-shoot (SS), and sliding window (SW)), two VMAT techniques via two partial arcs (SmartArc (SA) and RapidArc (RA)), and three HT techniques via three different fan beam widths (1 cm, 2.5 cm, and 5 cm) for 80 plans total. Fixed-beam and VMAT plans were generated using flattening filter-free beams. SS and SA, HT treatment plans, and SW and RA were optimized using Pinnacle v9.1, Tomoplan v.3.1.1, and Eclipse (Acuros XB v11.3 algorithm), respectively. Dose-volume histogram statistics, dose conformality, and treatment delivery efficiency were analyzed. VMAT treatment plans achieved significantly lower values for contralat-eral lung V5Gy (p ? 0.05) compared to the HT plans, and significantly lower mean lung dose (p < 0.006) compared to HT 5 cm treatment plans. In the comparison between the VMAT techniques, a significant reduction in the total monitor units (p = 0.05) was found in the SA plans, while a significant decrease was observed in the dose falloff parameter, D2cm, (p = 0.05), for the RA treatments. The maximum cord dose was significantly reduced (p = 0.017) in grouped RA&SA plans com-pared to SS. Estimated treatment time was significantly higher for HT and fixed-beam plans compared to RA&SA (p < 0.001). Although, a significant difference was not observed in the RA vs. SA (p = 0.393). RA&SA outperformed HT in all parameters measured. Despite an increase in dose to the heart and bronchus, this study demonstrates that VMAT is dosimetrically advantageous in treating early-stage NSCLC with SABR compared to fixed-beam, while providing significantly shorter treatment times.
| S-EPMC5874107 | biostudies-literature
Project description:RationaleWhether histologic subtype of non-small cell lung cancer (NSCLC) has an important effect on prognosis after surgery is unknown.ObjectivesWe hypothesized that we could predict mortality more effectively by integrating precise tumor size and histology rather than relying on conventional staging.MethodsWe used the SEER (Surveillance, Epidemiology, and End Results) registry. Inclusion criteria were as follows: (1) primary squamous cell or adenocarcinoma; (2) potentially curative surgery, defined as a lobectomy or bilobectomy; (3) lymph node dissection performed; and (4) pathologic stage IA or IB.Measurements and main resultsFrom 1988 to 2000, 7,965 patients were included. For both all-cause and lung cancer-associated mortality, tumor size demonstrated the strongest association (log-rank P < 0.0001 for each). When tumors were small (</=2 cm), lung cancer-associated mortality was similar for adenocarcinoma when compared with squamous cell carcinoma. When tumors were 3 cm or larger in size, lung cancer-associated mortality was higher for adenocarcinoma. The increased risk of lung cancer-associated mortality with adenocarcinoma was more pronounced in those younger than 65 years. Survival prediction using precise size and histology had much better discriminatory power than conventional TNM (tumor-node-metastasis) staging (P = 0.005).ConclusionsStaging that takes into account size, histology, late recurrence risk, and patient age is more accurate than the current TNM system and is clinically relevant because improved prediction can facilitate better decisions on the use of adjuvant chemotherapy.
| S-EPMC2258444 | biostudies-literature