Stereotactic Body Radiation Therapy (SBRT): An optimal approach in the treatment of lung cancer and pulmonary metastases – a Portuguese center experience

Inês Félix Pinto; Tomás Cabral Dinis; Leonor Martins; Inês Nobre-Góis; Filipa Vinagre; Ana Cleto; Margarida Borrego

doi:10.32932/gecp.2023.10.036

Authors

Inês Félix Pinto Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0009-0002-5962-5067
Tomás Cabral Dinis Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-3507-2966
Leonor Martins Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0003-2030-8072
Inês Nobre-Góis Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-1497-8988
Filipa Vinagre Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0009-0004-1589-0170
Ana Cleto Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0003-2811-204X
Margarida Borrego Radiotherapy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-9886-5971

DOI:

https://doi.org/10.32932/gecp.2023.10.036

Keywords:

Radiotherapy, SBRT, Lung cancer, Lung metastases

Abstract

Stereotactic Body Radiation Therapy (SBRT) is a noninvasive, safe, and effective treatment for early-stage lung cancer and metastatic lung disease in selected patients. Although there is no current consensus on the ideal dose and fractionation schedule for pulmonary SBRT, intensive regimens of BED ≥100 Gy are associated with significantly better local control and survival.The purpose of this study was to analyze fractionation schedules, toxicity and survival outcomes in patients with early-stage lung cancer and lung metastases treated with SBRT between January 2016 – December 2021 in our center. Toxicity was evaluated using CTCAE v5.0 and survival outcomes by the Kaplan–Meier method. We included 90 patients (110 tumors total) with a median age of 71 years and Karnofsky Performance Status≥90% in 74,4%. 42 patients (43 tumors) had early-stage primary lung cancer, mostly adenocarcinoma (76,2%), stage cT1b-cN0 (66,7%) and peripheral tumors (83,7%) with a median size of 20,5mm (8-50). 48 patients (67 tumors) had secondary lung disease mostly from colorectal cancer (66,7%), 70,1% were peripheral tumors with a median size of 11,5 mm (4-43 mm). Regarding toxicity, 8,9% of patients had pneumonitis (grade 1 and 2), 11,1% reported chest pain and 5,6% had rib fracture (grade 1). Median follow up was 22 months. In primary lung cancer, the 2-year tumor control (TC), overall survival (OS) and disease free survival (DFS) was 84,6%, 71,6% and 51,4%, respectively. Patients with lung metastases had a 2-year TC of 86,8%%, OS of 74% and DFS of 34,4%. SBRT is a well tolerated treatment option with favorable outcomes.

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References

World Health Organization (WHO). Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. WHO; 2020. Accessed March 09, 2023.

Gutiérrez E, Sánchez I, Díaz O, et al. Current evidence for stereotactic body radiotherapy in lung metastases. Current Oncology. 2021;28(4):2560-2578. doi:10.3390/curroncol28040233

Kristina Gregory N, Miranda Hughes O, Aisner DL, et al. NCCN Guidelines Version 2.2023 Non-Small Cell Lung Cancer Continue NCCN Guidelines Panel Disclosures.; 2023. https://www.nccn.org/home/member-

Chan M, Palma D, Barry A, et al. Practical Considerations for the Implementation of a Stereotactic Body Radiation Therapy Program for Oligo-Metastases. Adv Radiat Oncol. 2021;6(1):100499. doi:10.1016/j.adro.2020.06.004

Guckenberger M, Lievens Y, Bouma AB, et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020;21(1):e18-e28. doi:10.1016/S1470-2045(19)30718-1

Moreno AC, Fellman B, Hobbs BP, et al. Biologically Effective Dose in Stereotactic Body Radiotherapy and Survival for Patients With Early-Stage NSCLC. J Thorac Oncol. 2020;15(1):101-109. doi:10.1016/j.jtho.2019.08.2505

Videtic GMM, Donington J, Giuliani M, et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017;7(5):295-301. doi:10.1016/j.prro.2017.04.014

Bezjak A, Paulus R, Gaspar LE, et al. Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/RTOG 0813 Trial. J Clin Oncol. 2019;37(15):1316-1325. doi:10.1200/JCO.18.00622

Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630-637. doi:10.1016/S1470-2045(15)70168-3

Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiotherapy for operable stage I non-small-cell lung cancer (revised STARS): long-term results of a single-arm, prospective trial with prespecified comparison to surgery. Lancet Oncol. 2021;22(10):1448-1457. doi:10.1016/S1470-2045(21)00401-0

Onishi H, Shirato H, Nagata Y, et al. Stereotactic Body Radiotherapy (SBRT) for Operable Stage I Non–Small-Cell Lung Cancer: Can SBRT Be Comparable to Surgery? International Journal of Radiation Oncology*Biology*Physics. 2011;81(5):1352-1358. doi:10.1016/j.ijrobp.2009.07.1751

Crabtree TD, Denlinger CE, Meyers BF, et al. Stereotactic body radiation therapy versus surgical resection for stage I non–small cell lung cancer. J Thorac Cardiovasc Surg. 2010;140(2):377-386. doi:10.1016/j.jtcvs.2009.12.054

Ball D, Mai GT, Vinod S, et al. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial. Lancet Oncol. 2019;20(4):494-503. doi: 10.1016/S1470-2045(18)30896-9

Nyman J, Hallqvist A, Lund JÅ, et al. SPACE - A randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLC. Radiother Oncol. 2016;121(1):1-8. doi:10.1016/j.radonc.2016.08.015

Timmerman RD, Hu C, Michalski J, et al. Long-term Results of RTOG 0236: A Phase II Trial of Stereo- tactic Body Radiation Therapy (SBRT) in the Treatment of Patients with Medically Inoperable Stage I Non-Small Cell Lung Cancer. International Journal of Radiation Oncology*Biology*Physics. 2014;90(1):S30. doi:10.1016/j.ijrobp.2014.05.135

Timmerman RD, Paulus R, Pass HI, et al. Stereo-tactic Body Radiation Therapy for Operable Early-Stage Lung Cancer: Findings From the NRG Oncology RTOG 0618 Trial. JAMA Oncol. 2018;4(9):1263-1266. doi:10.1001/jamaoncol.2018.1251

Singh AK, Gomez-Suescun JA, Stephans KL, et al. One Versus Three Fractions of Stereotactic Body Radiation Therapy for Peripheral Stage I to II Non-Small Cell Lung Cancer: A Randomized, Multi-Institution, Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2019;105(4):752-759. doi:10.1016/j.ijrobp.2019.08.019

Videtic GMM, Hu C, Singh AK, et al. A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients With Stage I Peripheral Non-Small Cell Lung Cancer: NRG Oncology RTOG 0915 (NCCTG N0927). Int J Radiat Oncol Biol Phys. 2015;93(4):757-764. doi:10.1016/j.ijrobp.2015.07.2260

Kimura T, Nagata Y, Harada H, et al. Phase I study of stereotactic body radiation therapy for centrally located stage IA non-small cell lung cancer (JROSG10-1). Int J Clin Oncol. 2017;22(5):849-856. doi:10.1007/s10147-017-1125-y

Senthi S, Haasbeek CJA, Slotman BJ, Senan S. Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review. Radiother Oncol. 2013;106(3):276-282. doi:10.1016/j.radonc.2013.01.004

Giuliani M, Mathew AS, Bahig H, et al. SUNSET: Stereotactic Radiation for Ultracentral Non-Small-Cell Lung Cancer-A Safety and Efficacy Trial. Clin Lung Cancer. 2018;19(4):e529-e532. doi:10.1016/j.cllc.2018.04.001

Virbel G, Le Fèvre C, Noël G, Antoni D. Stereotactic Body Radiotherapy for Patients with Lung Oligometastatic Disease: A Five-Year Systematic Review. Cancers (Basel). 2021;13(14). doi:10.3390/cancers13143623

Siva S, Bressel M, Mai T, et al. Single-Fraction vs Multifraction Stereotactic Ablative Body Radiotherapy for Pulmonary Oligometastases (SAFRON II): The Trans Tasman Radiation Oncology Group 13.01 Phase 2 Randomized Clinical Trial. JAMA Oncol. 2021;7(10):1476-1485. doi:10.1001/jamaoncol.2021.2939

Videtic GMM, Reddy CA, Woody NM, Stephans KL. Ten-Year Experience in Implementing Single-Fraction Lung SBRT for Medically Inoperable Early-Stage Lung Cancer. International Journal of Radiation Oncology*Biology*Physics. 2021;111(2):436-442. doi:10.1016/j.ijrobp.2021.05.116

Guckenberger M, Belka C, Bezjak A, et al. Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: An ESTRO-ASTRO consensus statement. Radiother Oncol. 2020;146:223-229. doi:10.1016/j.radonc.2020.04.001

Kennedy WR, Gabani P, Nikitas J, Robinson CG, Bradley JD, Roach MC. Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT. Radiother Oncol. 2020;142:230-235. doi:10.1016/j.radonc.2019.08.010

Guckenberger M, Baus WW, Blanck O, et al. Definition and quality requirements for stereotactic radiotherapy: consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery. Strahlenther Onkol. 2020;196(5):417-420. doi:10.1007/s00066-020-01603-1

Timmerman R, McGarry R, Yiannoutsos C, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006;24(30):4833-4839. doi:10.1200/JCO.2006.07.5937

Bang A, Bezjak A. Stereotactic body radiotherapy for centrally located stage I non-small cell lung cancer. Transl Lung Cancer Res. 2019;8(1):58-69. doi:10.21037/tlcr.2018.10.07

Stereotactic Body Radiation Therapy (SBRT): An optimal approach in the treatment of lung cancer and pulmonary metastases – a Portuguese center experience

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