Great debate: surgery versus stereotactic radiotherapy for early-stage non-small cell lung cancer

Hiley, Crispin; Salem, Ahmed; Batchelor, Tim; McDonald, Fiona; Evison, Matthew

doi:10.1136/thoraxjnl-2019-214014

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…Lung cancer has long been the primary cause of cancerrelated deaths (1), and surgical resection has been the standard curative modality for early-stage disease (2,3), Although external beam radiotherapy (EBRT) had previously been applied for locally advanced or metastatic disease, precise tumor targeting using updated technologies namely, stereotactic body radiotherapy (SBRT), enable curative treatment. Unlike conventional EBRT, SBRT delivers a very high dose precisely to the target in a relatively short period, and recent randomized trials have shown that outcomes post-SBRT were comparable to those following surgery (4,5).…”

Section: Introductionmentioning

confidence: 99%

Dose-response relationship of stereotactic body radiotherapy for ultracentral tumor and comparison of efficacy with central tumor: a meta-analysis

Rim

Shin²,

Yoon

et al. 2020

Transl Lung Cancer Res

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Background: Ultracentral (UC) tumors, a subset of central lung tumors defined as those that abut the proximal bronchial tree (PBT), have been contraindicated for stereotactic body radiotherapy (SBRT). The present meta-analysis evaluated the efficacy of SBRT for UC and central tumors, and dose-response for local control (LC) of UC tumors. Methods: Databases including MEDLINE and EMBASE were searched up to March, 2020, to identify studies regarding SBRT for UC and/or central tumors. The primary endpoints were LC and overall survival (OS), while secondary endpoints were grade ≥3 and 5 complications.Results: Fourteen studies including 892 patients were included. In the UC and central tumor groups, the 1-year OS rates were 82.2% and 85.4% (P=0.556), respectively, and the 2-year OS rates were 66.4% and 71.9% (P=0.522), respectively. The 1-and 2-year LC rates in the UC and central tumor groups were 93.9% and 97.8% (P=0.023) and 90.4% and 93.7% (P=0.459), respectively. The pooled grade ≥3 complication rates in the UC and central tumor groups were 9.0% and 4.4% (P=0.06), while the corresponding grade 5 complication rates were 5.7% and 2.1% (P=0.087). The dose-response for LC was shown in the metaregression (P<0.0001), and 1-year LC rates were significantly different (94.4% vs. 59.3%, P<0.001) with very low heterogeneities in both subgroups, with threshold of 85 Gy10. Of the 28 fatalities, 12 (42.8%) were caused by hemorrhage or bronchial stenosis, and another 12 (42.8%) by pneumonia or respiratory failure. Conclusions:The oncologic outcomes of patients with UC and central tumors were comparable post-SBRT. A dose of at least ≥85 Gy10 is recommended for SBRT of UC tumors. Causes of complications should be further studied as UC tumors are more prone to serious toxicities.

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Section: Introductionmentioning

confidence: 99%

Dose-response relationship of stereotactic body radiotherapy for ultracentral tumor and comparison of efficacy with central tumor: a meta-analysis

Rim

Shin²,

Yoon

et al. 2020

Transl Lung Cancer Res

View full text Add to dashboard Cite

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“…However, a higher regional recurrence rate was noted in the radiotherapy group, but the trial also shows that any patients who might have suffered from recurrence were effectively treated with chemoradiation. Such patterns were not reported postsurgery and would be helpful to know for a true comparison [ 38 ]. A BMJ article by Khakwani et al identifies some issues with referring patients for radiotherapy alone—it notes considerable delays in the receipt of radiotherapy, which could negatively impact treatment outcomes [ 39 ].…”

Section: Resectable Diseasementioning

confidence: 99%

“…A BMJ article by Khakwani et al identifies some issues with referring patients for radiotherapy alone—it notes considerable delays in the receipt of radiotherapy, which could negatively impact treatment outcomes [ 39 ]. A potential reason for this delay may be the fact that patients have to be referred to specific commissioned centres to receive treatment, as not all radiotherapy centres in the UK can administer the stereotactic radiation required for NSCLC [ 38 , 39 ]. Maybe this indicates that rather than radiotherapy being ineffective as a treatment form, the provision of the service itself needs to be more streamlined.…”

Section: Resectable Diseasementioning

confidence: 99%

Stage 3 N2 Lung Cancer: A Multidisciplinary Therapeutic Conundrum

Carter,

Apte,

Shukla

et al. 2024

Curr Oncol Rep

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Purpose of Review The treatment of stage III N2 non-small cell lung cancer (NSCLC) remains debated. There is an absence of a universally agreed definition of resectability for this heterogeneous group and a lack of trial data. Recent Findings We reviewed and compared current international guidelines and evidence surrounding management of stage III N2 NSCLC. The Irish and Australian guidelines advise subcategorising N2 disease into N2a (may be resectable) and N2b (never resectable). On the contrary, American and British guidelines avoid subcategorising N2 disease, emphasising importance of local MDT decisions. It is suggested that evidence for resection of stage III tumours is relatively weak, but that stage IIIA should generally be considered for resection, and stage IIIB is not recommended for resection. For resectable disease, surgery may be combined with neoadjuvant chemoimmunotherapy, or adjuvant chemotherapy followed by immunotherapy and radiotherapy in selected patients. Summary There is some evidence that technically resectable disease can be treated solely with radiotherapy with similar outcomes to resection. In the event of unresectable disease, chemoradiotherapy has been the traditional management option. However, recent studies with chemoradiotherapy alongside immunotherapy appear promising. There are many factors that influence the treatment pathway offered to patients with stage III N2 NSCLC, including patient factors, team expertise, and local resources. Therefore, the role of MDTs in defining resectability and formulating an individualised treatment plan is crucial.

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“…octogenarians) have limited life expectancy and there may be less justification to undergo a high‐risk procedure, such as surgery, if this leads to a substantial decline in quality of life. This is particularly relevant as stereotactic ablative radiotherapy is increasingly seen as an alternative or even equivalent option 5 . The aim of the present study was to evaluate the short‐ and medium‐term outcomes of curative‐intent surgery for NSCLC in octogenarians.…”

Section: Male Female Totalmentioning

confidence: 99%

Surgical treatment of non‐small‐cell lung cancer in octogenarians: a single‐centre retrospective study

Chen

Kolbe

Christmas

2021

Internal Medicine Journal

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Lung resection in patients aged ≥80 years is considered high risk and contributes to the low rates of resection in this population. This review of 79 octogenarians who underwent curative surgery for non‐small‐cell lung cancer demonstrated no intraoperative mortality, 30‐day mortality of 1.3% and 12‐month mortality of 10%. In this selected cohort of octogenarians, surgery resulted in acceptable short‐ to medium‐term outcomes.

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Great debate: surgery versus stereotactic radiotherapy for early-stage non-small cell lung cancer

Cited by 8 publications

References 8 publications

Dose-response relationship of stereotactic body radiotherapy for ultracentral tumor and comparison of efficacy with central tumor: a meta-analysis

Dose-response relationship of stereotactic body radiotherapy for ultracentral tumor and comparison of efficacy with central tumor: a meta-analysis

Stage 3 N2 Lung Cancer: A Multidisciplinary Therapeutic Conundrum

Surgical treatment of non‐small‐cell lung cancer in octogenarians: a single‐centre retrospective study

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