Treatment-Related Adverse Effects in Lung Cancer Patients after Stereotactic Ablative Radiation Therapy

Abstract

Introduction Lung cancer is a disease which, despite the advancements in treatment, still has a very poor 5-year survival rate. Stereotactic ablative radiation therapy (SABR) is a highly advanced, sophisticated, and safe treatment which allows patients with early stage lung cancer to be treated effectively without invasive procedures and with excellent clinical outcomes. Avoiding surgery minimises morbidity and recovery time, bettering patients' quality of life. Furthermore, SABR allows patients unsuitable for surgery to still undergo curative treatment. Methods We aimed to review SABR-related normal tissue toxicities reported in the literature. While many studies assess safety, clinical efficacy, and disease control of SABR for lung cancer, the number of comprehensive reviews that analyse SABR-related side-effects is scarce. This integrative review summarises the toxicities reported in literature based on published clinical trials and tumour location (central or peripheral tumours) for available SABR techniques. Given that the majority of the clinical studies did not report on the statistical significance (e.g., p-values and confidence intervals) of the toxicities experienced by patients, statistical analyses cannot be performed. As a result, adverse events are compiled from clinical reports; however, due to various techniques and nonstandard toxicity reports, no meta-analysis is possible at the current stage of reported data. Results When comparing lobectomy and SABR in phase III trials, surgery resulted in increased procedure-related morbidity. In phase II trials, very few studies showed high grade toxicities/fatalities as a result of SABR for lung cancer. Gross target volume size was a significant predictor of toxicity. An ipsilateral mean lung dose larger than 9 Gy was significantly associated with radiation pneumonitis. Conclusions Based on the studies reviewed SABR is a safe treatment technique for lung cancer; however, further well-designed phase III randomised clinical trials are required to produce timely conclusive results and to enable their comparison and statistical analysis.

Long-term Dependency in Older Adults After Surgery or Stereotactic Body Radiation Therapy for Stage I Non–Small Cell Lung Cancer

“…Rib fractures are also a rare (<5%) and late (9 to 12 months) complication of SBRT. These events are often managed conservatively and with a small impact on quality of life 45,46 . While more conclusive data on adverse events and their impact on functional outcomes are yet to emerge, SBRT is considered a safe treatment technique in this setting 45,46 …”

Cost-effectiveness of stereotactic body radiation therapy versus video assisted thoracic surgery in medically operable stage I non-small cell lung cancer: A modeling study

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The multidisciplinary management of oligometastases from colorectal cancer: a narrative review

“…It has many advantages over surgical resection, being noninvasive, delivered as an outpatient, and well-tolerated, in even very infirm patients. It is routinely used in patients who are medically inoperable (47,48). In addition to treating lung and liver oligometastases, SABR is used to treat bone, lymph node and other soft tissue metastases (49).…”