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

Singh, Anurag; Gomez-Suescun, Jorge A.; Stephans, Kevin L.; Bogart, Jeffrey A.; Hermann, Gregory M.; Tian, Lili; Groman, Adrienne; Videtic, Gregory M.M.

doi:10.1016/j.ijrobp.2019.08.019

Cited by 93 publications

(91 citation statements)

References 24 publications

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“… 120 Rigid immobilization and image guidance are critical; this is especially relevant for single-fraction SBRT because the mitigation of random setup error effects achieved by delivering multiple fractions is not applicable. In addition, early adopters of single-fraction SBRT have recognized that accounting for and minimizing motion are crucial, and therefore they routinely use techniques including an internal target volume with abdominal compression for LINAC-based treatment 19 , 20 , 86 or with tumor tracking on CyberKnife. 70 , 85 Interestingly, there is a paucity of single-fraction SBRT outcomes reported with patients treated in breath hold, which is 1 of the most effective means to reduce the volume of normal tissue receiving at least the prescription dose and therefore the risk of potentially severe toxicity.…”

Section: Discussionmentioning

confidence: 99%

Single-Fraction Stereotactic Body Radiation Therapy: A Paradigm During the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond?

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Lee

et al. 2020

Advances in Radiation Oncology

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Purpose Owing to the coronavirus disease 2019 (COVID-19) pandemic, radiation oncology departments have adopted various strategies to deliver radiation therapy safely and efficiently while minimizing the risk of severe acute respiratory syndrome coronavirus–2 transmission among patients and health care providers. One practical strategy is to deliver stereotactic body radiation therapy (SBRT) in a single fraction, which has been well established for treating bone metastases, although it has been infrequently used for other extracranial sites. Methods and Materials A PubMed search of published articles in English related to single-fraction SBRT was performed. A critical review was performed of the articles that described clinical outcomes of single-fraction SBRT for treatment of primary extracranial cancers and oligometastatic extraspinal disease. Results Single-fraction SBRT for peripheral early-stage non-small cell lung cancer is supported by randomized data and is strongly endorsed during the COVID-19 pandemic by the European Society for Radiotherapy and Oncology-American Society for Radiation Oncology practice guidelines. Prospective and retrospective studies supporting a single-fraction regimen are limited, although outcomes are promising for renal cell carcinoma, liver metastases, and adrenal metastases. Data are immature for primary prostate cancer and demonstrate excess late toxicity in primary pancreatic cancer. Conclusions Single-fraction SBRT should be strongly considered for peripheral early-stage non-small cell lung cancer during the COVID-19 pandemic to mitigate the potentially severe consequences of severe acute respiratory syndrome coronavirus–2 transmission. Although single-fraction SBRT is promising for the definitive treatment of other primary or oligometastatic cancers, multi-fraction SBRT should be the preferred regimen owing to the need for additional prospective evaluation to determine long-term efficacy and safety.

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Section: Discussionmentioning

confidence: 99%

Single-Fraction Stereotactic Body Radiation Therapy: A Paradigm During the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond?

Ning

Lee

et al. 2020

Advances in Radiation Oncology

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“…To date, available SBRT regimens for early-stage NSCLC involve 30-34 Gy × 1 fraction, 15-20 Gy × 3 fractions, 12 Gy × 4 fractions, and 10-12 Gy × 5 fractions, with the most common overall being the latter two [71]. A randomized phase II trial showed that 30 Gy in one fraction was equivalent to 60 Gy in three fractions with regard to toxicity, local control, PFS, and OS in the treatment of peripheral stage I-II NSCLC [72]. Similarly, the phase 2 RTOG 0915 study also found that a single fraction of 34 Gy and 48 Gy in 4 fractions achieved similar 5-year primary tumor control rates, with the single fraction regimen leading to slightly fewer grade 3 or higher adverse events [73,74].…”

Section: Future Challenges and Directions For Sbrt Combined With Pd-1mentioning

confidence: 99%

SBRT combined with PD-1/PD-L1 inhibitors in NSCLC treatment: a focus on the mechanisms, advances, and future challenges

et al. 2020

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Immune checkpoint inhibitors targeting programmed cell death 1 (PD-1), programmed cell death ligand-1 (PD-L1), and others have shown potent clinical efficacy and have revolutionized the treatment protocols of a broad spectrum of tumor types, especially non-small-cell lung cancer (NSCLC). Despite the substantial optimism of treatment with PD-1/PD-L1 inhibitors, there is still a large proportion of patients with advanced NSCLC who are resistant to the inhibitors. Preclinical and clinical trials have demonstrated that radiotherapy can induce a systemic antitumor immune response and have a great potential to sensitize refractory "cold" tumors to immunotherapy. Stereotactic body radiation therapy (SBRT), as a novel radiotherapy modality that delivers higher doses to smaller target lesions, has shown favorable antitumor effects with significantly improved local and distant control as well as better survival benefits in various solid tumors. Notably, research has revealed that SBRT is superior to conventional radiotherapy, possibly because of its more powerful immune activation effects. Thus, PD-1/PD-L1 inhibitors combined with SBRT instead of conventional radiotherapy might be more promising to fight against NSCLC, further achieving more favorable survival outcomes. In this review, we focus on the underlying mechanisms and recent advances of SBRT combined with PD-1/PD-L1 inhibitors with an emphasis on some future challenges and directions that warrant further investigation.

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“…The ESTRO-ASTRO consensus group was unanimous in recommending SABR in a patient with stage I NSCLC referred by a surgeon because of operating room closures or delays ( 32 ). Their group also supported delivering SABR as a single fraction if the treating physician wished to reduce the number of visits in the early pandemic phase ( 25 , 26 , 32 ).…”

Section: Challenges During Covid19 Pandemicmentioning

confidence: 99%

“…Two recent randomized trials have indicated promising results when using a single-fraction SABR approach (one dose of 30–34 Gy), with similar toxicity and oncologic outcomes compared to a 3-fraction (60 Gy) regimen and a 4-fraction (48 Gy regimen) ( 25 , 26 ). During the COVID-19 pandemic, the single-fraction SABR approach has the advantage of reducing visits to radiotherapy departments down to only two: one visit for CT simulation, and one visit for treatment ( 25 , 26 , 32 ).…”

Section: Challenges During Covid19 Pandemicmentioning

confidence: 99%

SABR-BRIDGE: Stereotactic ABlative Radiotherapy Before Resection to AvoId Delay for Early-Stage LunG Cancer or OligomEts During the COVID-19 Pandemic

et al. 2020

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Surgical resection is the standard-of-care approach for early-stage non-small cell lung cancer (NSCLC). Surgery is also considered an acceptable standard infit patients with oligometastatic lesions in the lungs. The COVID-19 pandemic has led to worldwide issues with access to operating room time, with patients and physicians facing uncertainty as to when surgical resection will be available, with likely delays of months. Further compounding this are concerns about increased risks of respiratory complications with lung cancer surgery during active phases of the pandemic. In this setting, many thoracic oncology teams are embracing a paradigm where stereotactic ablative radiotherapy (SABR) is used as a bridge, to provide radical-intent treatment based on a combination of immediate SABR followed by planned surgery in 3-6 months. This pragmatic approach to treatment has been named SABR-BRIDGE (Stereotactic ABlative Radiotherapy Before Resection to avoId Delay for early-stage lunG cancer or oligomEts). This term has also been applied to the pragmatic study of the outcomes of this approach. In this paper, we discuss the standards of care in treatment of early-stage (NSCLC) and pulmonary oligometastases, the impetus for the SABR-BRIDGE approach, and the controversies surrounding assessment of pathological response to neo-adjuvant radiation therapy.

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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

Cited by 93 publications

References 24 publications

Single-Fraction Stereotactic Body Radiation Therapy: A Paradigm During the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond?

Single-Fraction Stereotactic Body Radiation Therapy: A Paradigm During the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond?

SBRT combined with PD-1/PD-L1 inhibitors in NSCLC treatment: a focus on the mechanisms, advances, and future challenges

SABR-BRIDGE: Stereotactic ABlative Radiotherapy Before Resection to AvoId Delay for Early-Stage LunG Cancer or OligomEts During the COVID-19 Pandemic

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