Stereotactic Ablative Radiation Therapy for the Treatment of Early-stage Non–Small-Cell Lung Cancer: CEPO Review and Recommendations

Abstract

Considering the evidence available to date, the Comité de l'évolution des pratiques en oncologie recommends the following: (1) for medically operable patients with stage T1-2N0M0 NSCLC, surgery remains the standard treatment because comparative data regarding the efficacy of SABR and surgery are currently insufficient for SABR to be considered an equivalent alternative to surgery for these patients; (2) for medically inoperable patients with stage T1-2N0M0 NSCLC or medically operable patients who refuse surgery, SABR should be preferred to standard EBRT (grade B recommendation); (3) the biological equivalent dose (BED(10)) used for SABR treatment should be at least 100 Gy (grade B recommendation); (4) for patients with a central tumor, a large-volume tumor (large planning target volume) or severe pulmonary comorbidity, a risk-adaptive schedule should be used (dose reduction or increase in the number of fractions; grade B recommendation); (5) the choice of using SABR to treat NSCLC should be discussed within tumor boards; treatment with SABR (or with standard EBRT) should not be considered for patients whose life expectancy is very limited because of comorbidities (grade D recommendation).

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

“…32 Our study, however, has several limitations: as a matter of fact, only half of the patients received a prescription dose which is consistent with recommended guidelines supporting a BED 10 used for SABR treatment of at least 100 Gy. [33][34][35] Our practice has been to treat frail patients with large target volumes and/or central tumours with a less-intensive dose-fractionation schedule, which is reflected in the delivery of a lower BED 10 . This might account for the relatively lower rate of local control, which compares unfavourably with the current non-HT-SABR experience whereby, with higher doses, local control rates in excess of 90% have been widely reported.…”

ESTRO ACROP consensus guideline on implementation and practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer

“…Oncology (ASTRO) and American College of Radiology (ACR) on image-guided radiotherapy and SBRT in general [13,14]; European Organisation for Research and Treatment of Cancer (EORTC) on high precision radiotherapy [15]; American Association of Physicists in Medicine (AAPM) on SBRT in general [16]; UK National Radiotherapy Implementation Group Report on implementation of SBRT in general [17]; Canadian Association of Radiation Oncology (CARO) on practice guideline for lung, liver and spine SBRT [18]; German Society for Radiotherapy and Oncology (DEGRO) on SBRT practice for early stage NSCLC [19]; and Canadian Comité de l'évolution des pratiques en oncologie (CEPO) on SBRT for early stage NSCLC [20].…”

Prognostic Value of Pretreatment Circulating Neutrophils, Monocytes, and Lymphocytes on Outcomes in Lung Stereotactic Body Radiotherapy

“…The technique can be used in patients of advanced age and with significant medical comorbidities, demonstrating good clinical outcomes and minimal toxicity 3 . As sbrt becomes readily available, selecting patients who will benefit from treatment in the setting of advanced medical comorbidities is an increasing clinical challenge 4 .…”