Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists

Abstract

The past 2 decades have seen a rapid growth in use of stereotactic body radiation therapy (SBRT) for the management of non-small cell lung cancer (NSCLC). Not only is SBRT the reference standard for treatment of early-stage node-negative NSCLC in medically inoperable patients, it is also currently challenging the role of surgery for early-stage operable disease. SBRT is also used to treat recurrent disease and has a role in the management of multiple synchronous lung cancers. Imaging changes after SBRT differ from the changes after conventional radiation therapy in many ways, the knowledge of which is pertinent for accurate image interpretation. Posttreatment response assessment and detection of recurrent disease are heavily reliant on radiologic assessment, and often the decision to treat recurrent disease is based on the imaging findings themselves. This article provides a comprehensive review of the concepts of SBRT and the current indications for its use in the treatment of early-stage NSCLC, as well as a discussion of the CT findings seen after SBRT compared with the changes after conventional radiation therapy. Radiologic findings that are suggestive of recurrent disease and the imaging pitfalls are also highlighted. Finally, the rare complications after SBRT are described. SBRT is a major component of the changing treatment paradigms for early- and late-stage NSCLC. The imaging findings after SBRT often determine the next steps in a patient's clinical management. Therefore, radiologists must be familiar with the uses of this therapy and its radiologic appearance to be able to effectively contribute to the care of patients with NSCLC. RSNA, 2018.

Patterns of Pretreatment Diagnostic Assessment in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC): Special Characteristics in the COVID Pandemic and Influence on Outcomes

“…Here, SBRT has advantages when compared to surgery [ 24 ]. Additionally, SBRT is favorable during the pandemic because it is applied in a few fractions and can be delivered as a convenient outpatient procedure [ 25 ]. Couñago et al emphasized that SBRT is an important option during the pandemic, both for operable and inoperable NSCLC patients [ 15 , 26 ].…”

Artificial Intelligence in Lung Cancer: Bridging the Gap Between Computational Power and Clinical Decision-Making

“…Studies are currently examining SABR in early-stage operable NSCLC, compared to the historical standard of surgery. 48 However, treatment with SABR has associated side effects, including radiationinduced lung injury (RILI). Symptomatic RILI, divided into acute radiation pneumonitis and chronic fibrosis, occurs in around 25% of patients who receive SABR.…”

“…With the emergence of SABR as a primary treatment option for early-stage NSCLC, the need for accurate response assessment following treatment will be of increasing importance. 48 In addition to the clinical toxicities reported above, imaging-based response assessment of local recurrence remains challenging. The presence of post-radiation radiological changes, including fibrosis, on follow-up CT can mimic the appearance of a recurring tumor (Figure 4).…”

Metabolic Alterations in Sputum and Exhaled Breath Condensate of Early Stage Non-Small Cell Lung Cancer Patients After Surgical Resection: A Pilot Study

“…While biopsy and/or SR provide a histopathological diagnosis, these approaches may not be feasible in patients with severe chronic obstructive pulmonary disease (COPD) or other limiting co-morbidities (6). Further, it is extremely difficult to detect cancer recurrence based on CT or PET scan post-surgery and even more challenging after SABR (7,8). Therefore, biomarkers identified and obtained through non-invasive approaches could potentially serve as an effective therapeutic tool for early cancer detection, treatment response assessment, and cancer recurrence monitoring (4).…”