Stereotactic Ablative Body Radiotherapy Versus Radical Radiotherapy: Comparing Real-World Outcomes in Stage I Lung Cancer

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

“…The increased tumour control using a higher BED was demonstrated recently in the phase III randomised CHISEL trial, which reported significantly reduced local failure rates in patients with peripheral tumours treated with SABR compared with conventionally fractionated radiotherapy (14% vs 31%) and an improvement in overall survival (OS) 1. This is reflected in real-world data from the UK National Lung Cancer Audit (NLCA), which showed that the HR for death for those who underwent SABR was 0.69 compared with conventionally fractionated radiotherapy 2…”

Curative Radiotherapy for Non-small Cell Lung Cancer: Practice Changing and Changing Practice?

“…Importantly, the 2018 updated UK SABR Consortium Audit [9] documents an increase in SABR provision, with the number of centres commissioned to deliver SABR rising from 12 in 2012 to 38. However, the 2018 survey also showed that SABR is not currently offered in around 40% of UK radiotherapy centres, a finding that highlights that the concerns raised by Phillips et al [2] from the 2015e2016 data are still present. The results relating to travel time suggest that improvements in SABR provision and commissioning across the UK are urgently needed to ensure that medically inoperable and high-risk surgical patients are offered SABR over more conventional radiotherapy or no treatment, both associated with worse outcomes.…”

“…With technical advances in radiotherapy planning and delivery, the question arises as to when is the appropriate time and what level of evidence is required to change practice? It is with this background that two of the articles in this lung cancer miniseries, both using linked datasets to supplement data collected through the National Lung Cancer Audit in 2015e2016, concentrate on curative-intent radiotherapy approaches in current day to day practice across the UK [2,3].…”

“…In the first article, Phillips et al [2] study the treatment modality and outcomes for patients presenting with stage I non-small cell lung cancer (NSCLC), showing that just over 70% of patients were treated with curative intent, with around 20% receiving radical radiotherapy. The focus of the paper is on the planning and delivery of radiotherapy, which has benefited from several major developments.…”

“…The paper by Phillips et al [2] reports that the percentage of patients undergoing SABR in England has increased from 64% in 2015 to 73% in 2016. Importantly, the 2018 updated UK SABR Consortium Audit [9] documents an increase in SABR provision, with the number of centres commissioned to deliver SABR rising from 12 in 2012 to 38.…”