Stereotactic Body Radiotherapy Effective for Treatment of Inoperable Non-Small-Cell Lung Cancer

A radiosurgical approach that destroys lung and other tumors using precisely-shaped, high dose X-ray beams has been shown to be effective for treating early-stage, high-risk, non-small-cell lung cancer in patients who cannot be operated on, and new research has been designed to assess the usefulness of this approach.

In the September 2012 issue the Journal of Thoracic and Cardiovascular Surgery, an article was published that summarized the objectives of an ongoing phase III study comparing stereotactic body radiotherapy (SBRT) with surgery for the treatment of early-stage, high-risk, operable non-small cell lung cancer. This group of patients is frequently referred to as being medically inoperable. SBRT is also known as stereotactic ablative body radiotherapy (SABR) for its unique radiobiologic features that can initiate increased tumor response and high humor control rates.

Standard-risk operable patients with lung cancer are usually treated with surgery to remove the affected lobe (lobar resection). Patients who cannot tolerate complete removal of a lobe, but who are still deemed healthy enough to undergo general anesthesia, frequently referred to as “high-risk, operable” patients, are typically treated with sublobar resection.

“Several investigators have suggested that SBRT might be equally effective for these high-risk operable patients,” said Dr. Robert Timmerman, study cochair. “We set up this randomized study to compare SBRT, which is a noninvasive therapy, with surgery. We’ll be looking at patients’ overall, disease-free, and regional recurrence-free survival rates three years after treatment, and also comparing adverse events and post-treatment quality of life measures.”

“The primary objective of the study is to determine whether patients treated with SBRT have three-year overall survival rates that are no more than 10% less than patients treated with sublobar resection,” said Hiran C. Fernando, MD, study chairman. “Although it is certainly attractive to patients to have a less invasive therapy, with lower risks, we need to know whether this translates into better cancer control or survival.”

Sponsored by the US National Cancer Institute (NCI; Bethesda, MD, USA), the study is being managed by the Alliance for Clinical Trials in Oncology (Chicago, IL, USA), an NCI-sponsored research cooperative that was formed in March 2011 from the merger of the American College of Surgeons Oncology Group (ACOSOG), Cancer and Leukemia Group B (CALGB), and the North Central Cancer Treatment Group (NCCTG). The study plans to compile 420 patients over a five-year period.

In September 2012, Varian Medical Systems (Palo Alto, CA, USA) became the exclusive corporate supporter of this study, specifically to support institutions, as well as the overall conduct of the trial by the Alliance for Clinical Trials in Oncology. Varian TrueBeam and Trilogy medical linear accelerator systems are included in the techniques that can be used to perform SBRT procedures.

“We are hoping that more cancer treatment centers will complete the credentialing process and participate in the study, so that we can accrue a sufficient number of patients in a reasonable timeframe,” concluded Dr. Fernando. “We believe that this study will help us make better decisions about when to use surgery and when to use SBRT, so that surgeons and radiation oncologists can work together more effectively to counsel patients regarding the risks and benefits of each approach.”

Related Links:
US National Cancer Institute
Alliance for Clinical Trials in Oncology
Varian Medical Systems