Stereotactic Ablative Radiotherapy for Inoperable Early-Stage Lung Cancer
Posted: Monday, April 22, 2019
According to research published in The Lancet Oncology, stereotactic ablative radiotherapy (SABR) was more effective in controlling local tumor progression in patients with inoperable stage 1 non–small cell lung cancer (NSCLC) than standard radiotherapy. “SABR resulted in superior local control of the primary disease without an increase in major toxicity,” concluded David Ball, MD, of the MacCallum Cancer Centre, Australia, and colleagues. “The findings of this trial suggest that SABR should be the treatment of choice for this patient group.”
The multicenter, phase III trial enrolled 101 patients between December 2009, and June 2015; all patients had stage I NSCLC as confirmed by biopsy and had refused or were ineligible for surgery. Participants were randomly selected to receive either SABR (n = 66) or standard radiotherapy (n = 35). SABR consisted of 54 Gy in three 18-Gy fractions or 48 Gy in four 12-Gy fractions if the tumor was < 2 cm from the chest wall. Standard radiotherapy consisted of 66 Gy in 33 daily 2-Gy fractions or 50 Gy in 20 daily 2.5-Gy fractions, depending on the preference of the institution.
At a median follow-up of 2.6 years for participants in the SABR group, 9 patients (14%) had experienced local disease progression, compared with 11 patients (31%) in the standard group, whose median follow-up occurred at 2.1 years. For both groups, the median time to local treatment failure was not reached.
As for toxicity, there were seven grade 3 adverse events with SABR (cough, hypoxia, lung infection, weight loss, dyspnea, and fatigue) and one grade 4 adverse event (dyspnea). With standard radiotherapy, there were two grade 3 events (chest pain).
Disclosure: The study authors’ disclosure information may be found at thelancet.com.