Inoperable Early-Stage Non–Small-Cell Lung Cancer: Stereotactic Ablative Radiotherapy and Rationale for Systemic Therapy

2022 ◽  
Author(s):  
Megan E. Daly
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Systemic Therapy ◽  
Early Stage ◽  
Small Cell ◽  
Phase Iii ◽  
Tumor Control ◽  
Stereotactic Ablative Radiotherapy ◽  
Small Cell Lung

Stereotactic ablative radiotherapy (SABR) is the standard treatment for medically inoperable, early-stage non–small-cell lung cancer. SABR results in high rates of in-field tumor control, but among larger and more biologically aggressive tumors, regional and distant failures are problematic. Cytotoxic chemotherapy is rarely used in this patient population and the benefit is unclear. Alternative systemic therapy options with a milder side-effect profile are of considerable interest, and several randomized phase III trials are currently testing immune checkpoint inhibitors in this setting. We review the rationale, data, and ongoing studies evaluating systemic therapy in medically inoperable, early-stage non–small-cell lung cancer treated with SABR.

scholarly journals Surgery in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 390
Author(s):  
Nicola Martucci ◽  
Alessandro Morabito ◽  
Antonello La Rocca ◽  
Giuseppe De Luca ◽  
Rossella De Cecio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Stage I ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.

Salvage guideline for local-regional failure after stereotactic ablative radiotherapy for early-stage non-small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8501-8501 ◽  
Author(s):  
Eric Brooks ◽  
Bing Sun ◽  
Lina Zhao ◽  
Ritsuko Komaki ◽  
Zhongxing X. Liao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Long Term Results ◽  
Regional Recurrence ◽  
Stereotactic Ablative Radiotherapy ◽  
Small Cell Lung ◽  
Local Regional Recurrence

8501 Background: Up to 1 in 7 patients receiving stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC) will develop local-regional recurrence. While SABR is the pillar of treatment for medically inoperable patients, little is known about outcomes and management for this potentially curable, local-regionally recurrent patient group. Methods: We present the first long-term results for the largest group of salvaged patients with local-regional recurrence after SABR. 772 patients with clinically early-stage I-II NSCLC were treated with SABR (50 Gy in 4 or 70 Gy in 10 fractions) between 2004-2014 at our center. Patients with isolated local recurrence (LR, n = 34) or regional recurrence (RR, n = 41) were analyzed and compared to patients with no recurrence (NR, n = 569). Results: Median time to LR or RR after SABR was 14 months. Salvage was performed in 79.4% of LR and 92.7% of RR patients. Salvage consisted of surgery (20% LR, 2% RR), re-irradiation (24% LR, 17% RR), radiofrequency ablation (15% LR), chemotherapy (15% LR, 26% RR), and chemoradiation (6% LR, 44% RR) based on a standard multi-disciplinary decision approach (Figure 1). 5-year OS was 37.1% for LR and 39.1% for RR patients. Of LR and RR patients, those receiving salvage had significantly better 5-year OS compared to those not receiving salvage (45.2% LR, 42.9% RR, 0% no salvage; p = 0.009). 5-year OS for salvaged patients was not statistically different from patients with NR (53.5% NR, p = 0.466). 5-year lung-cancer specific survival was 51% for LR and 55.1% for RR patients. Subsequent DM occurred in 20.5% of LR and 29.3% of RR patients at a median of 8.4-10.3 months. No salvaged patient experienced grade 5 toxicity. Conclusions: Patients with local or regional recurrence after SABR have excellent outcomes with salvage therapy, with no statistical difference in 5- year OS between LR and RR patients salvaged after SABR, and patients with no recurrence. Because a standard multidisciplinary approach was applied to any LR or RR patient after SABR, a novel treatment algorithm is generated. We offer a much needed management guide for thoracic oncologists treating patients who local-regionally recur after SABR.

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