Curative radiation therapy for lung tumours in a single visit
Curative radiation therapy for lung tumours in a single visit
The preferred approach for cure of small lung cancers (stage I disease) using ative radiotherapy is with a technique known as stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiotherapy(SBRT). SABR delivers high radiation doses, and has been in clinical use for 25 years [1]. SABR is mainly used for patients with a stage I lung cancer who are either unfit to undergo surgery, or who have declined a surgical procedure.
In the past, SABR was delivered in between 3 to 5 treatment sessions (or fractions). More recent research reported survival outcomes for patients with small lung tumors who received a single dose of SABR compared to SABR delivered over 3 or 4 sessions[2, 3]. In another study, patients with 1-3 metastases that had spread to the lungs, results of single-session of SABR was also found to be comparable to SABR delivered in 4 sessions in terms of treatment effectiveness, survival and quality of life [4].
Patients suitable for single-session SABR have tumors less than 5 cm that are away from the large airways, large blood vessels and the chest wall. Most cancer centers have equipment suitable for delivery of standard SABR, but single-session SABR is generally performed at more experienced centers. Depending on the equipment used, you may have to have an initial visit for treatment preparations, where images of your body are made. For single-session SABR treatments, you will be required to lie on the treatment couch for between 30 minutes and 1 hour for the entire procedure. Possible side effects include tiredness, pain on the chest wall and lung inflammation.
Single session SABR is more convenient and just as safe for people who meet the criteria above with early-stage lung cancer or up to 3 lung metastases.
The author of the article Professor Suresh Senan has received institutional research support from Varian Medical System, ViewRay Inc., AstraZeneca and BMS. Professor Senan also part of the Advisory board for Varian Medical System, ViewRay Inc., AstraZeneca, Roche, MSD, Janssen and BeiGene.
Reference
[1] Blomgren H, Lax I, Näslund I, Svanström R. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncologica. 1995;34(6):861-70.
[2] Videtic GM, Paulus R, Singh AK, Chang JY, Parker W, Olivier KR, Timmerman RD, Komaki RR, Urbanic JJ, Stephans KL, Yom SS, Robinson CG, Belani CP, Iyengar P, Ajlouni MI, Gopaul DD, Gomez Suescun JB, McGarry RC, Choy H, Bradley JD. Long-term Follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients With Stage I Peripheral Non-Small Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics. 2019 Apr 1;103(5):1077-1084.
[3] Singh AK, Gomez-Suescun JA, Stephans KL, Bogart JA, Hermann GM, Tian L, Groman A, Videtic GM. One Versus Three Fractions of Stereotactic Body Radiation Therapy for Peripheral Stage I to II Non-Small Cell Lung Cancer: A Randomized, Multi-Institution, Phase 2 Trial. International Journal of Radiation Oncology, Biology, Physics. 2019 Nov 15;105(4):752-759.
[4] Siva S, Bressel M, Mai T, Le H, Vinod S, de Silva H, Macdonald S, Skala M, Hardcastle N, Rezo A, Pryor D, Gill S, Higgs B, Wagenfuehr K, Montgomery R, Awad R, Chesson B, Eade T, Wong W, Sasso G, De Abreu Lourenco R, Kron T, Ball D, Neeson P. Single-Fraction vs Multifraction Stereotactic Ablative Body Radiotherapy for Pulmonary Oligometastases (SAFRON II): The Trans Tasman Radiation Oncology Group 13.01 Phase 2 Randomized Clinical Trial. JAMA Oncology. 2021 Oct 1;7(10):1476-1485.