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Treatment Options for Early-Stage Lung Cancer Patients Stereotactic body radiotherapy deserves further study in patients who are not eligible for lobectomies.

ONCOLOGY AND HEMATOLOGY for February 23, 2010 
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Treatment Options for Early-Stage Lung Cancer Patients
[Summary and Comment | Subscription Required]

Stereotactic body radiotherapy deserves further study in patients who are
not eligible for lobectomies.
   By Lin-Chi Chen, MD, PhD
   February 23, 2010
   Covering: Grills IS et al. J Clin Oncol 2010 Feb 20; 28:928
   Timmerman RD. J Clin Oncol 2010 Feb 20; 28:907
   Altorki NK. J Clin Oncol 2010 Feb 20; 28:905
   http://oncology-hematology.jwatch.org/cgi/content/full/2010/223/1?q=etoc_jwonchem

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FREE FULL-TEXT ARTICLE

Summary and Comment

Treatment Options for Early-Stage Lung Cancer Patients
Stereotactic body radiotherapy deserves further study in patients who are
not eligible for lobectomies.



Patients with stage I lung cancer typically undergo lobectomies unless they
have contraindications, such as significant cardiopulmonary comorbidities.
In such patients, radiation therapy or less-extensive surgery (i.e.,
sublobar, wedge, or segmental resection) can be utilized. Stereotactic body
radiotherapy (SBRT) allows precise, high-dose treatment of tumor tissue and
is associated with high rates of local tumor control as well as short
duration of treatment. Few data, however, directly compare outcomes after
surgery versus SBRT. To address this issue, investigators evaluated
recurrence and survival rates in 55 patients with stage I non-small-cell
lung cancer who were treated with SBRT (as part of a prospective trial).
These outcomes were compared with those in 69 patients with early-stage
lung cancer (obtained through retrospective chart review) who were treated
with wedge resection.

At 30 months, patients who received SBRT tended to have better local tumor
control than patients who underwent wedge resection, but the findings were
not statistically significant (local recurrence rates, 4% and 20%; P=0.07).
Cause-specific survival was similar in both groups (93% and 94%), but
overall survival favored those who had surgery (72% vs. 87%; P=0.01).

Comment: As editorialists note, these findings are provocative and
hypothesis generating, but definitive conclusions cannot be drawn from
retrospective review of the data. The role of SBRT in early-stage lung
cancer continues to evolve; until optimal use of SBRT is better defined,
thoracic oncologists should continue to evaluate patients using a
multidisciplinary approach that includes input, if possible, from
pulmonologists, medical oncologists, radiation oncologists, and thoracic
surgeons to determine the best treatment options for each patient.

-- Lin-Chi Chen, MD, PhD

Published in Journal Watch Oncology and Hematology February 23, 2010
Citation(s):

Grills IS et al. Outcomes after stereotactic lung radiotherapy or wedge
resection for stage I non-small-cell lung cancer. J Clin Oncol 2010 Feb 20;
28:928. (Subscription may be required) (Free)

Timmerman RD. Surgery versus stereotactic body radiation therapy for
early-stage lung cancer: Who's down for the count? J Clin Oncol 2010 Feb
20; 28:907. (Subscription may be required) (Free)

Altorki NK. Stereotactic body radiation therapy versus wedge resection for
medically inoperable stage I lung cancer: Tailored therapy or one size fits
all? J Clin Oncol 2010 Feb 20; 28:905. (Subscription may be required)
(Free)

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