Practical considerations of single-fraction stereotactic ablative radiotherapy to the lung. (August 2022)

• Record Type: Journal Article
• Authors: Kang, Therese MJ.; Hardcastle, Nicholas; Singh, Anurag K.; Slotman, Ben J.; Videtic, Gregory M.M.; Stephans, Kevin L.; Couñago, Felipe; Louie, Alexander V.; Guckenberger, Matthias; Harden, Susan V.; Plumridge, Nikki M.; Siva, Shankar
• Is Part Of: Lung cancer. Volume 170(2022)
• Page Start: 185
• Page End: 193
• Publication Date: 2022-08
• Subjects: SABR -- NSCLC -- Single fraction -- Lung cancer -- Lung oligometastases -- Radiation therapy; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2022.06.014
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Single-fraction SABR offers high local control and low toxicity in inoperable stage I lung cancer and lung oligometastases. Excess toxicity with central lung lesions has been reported. Proximity to brachial plexus and chest wall are not relative contraindications; risks are similar to multi-fraction SABR. Single-fraction SABR plans require additional technical considerations to balance treatment time and interplay effects. Prospective studies are needed for central targets, interstitial lung disease, and to maximise immunomodulatory effects. Abstract: Stereotactic ablative radiotherapy (SABR) is a well-established treatment for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and pulmonary oligometastases. The use of single-fraction SABR in this setting is supported by excellent local control and safety profiles which appear equivalent to multi-fraction SABR based on the available data. The resource efficiency and reduction in hospital outpatient visits associated with single-fraction SABR have been particularly advantageous during the COVID-19 pandemic. Despite the increased interest, single-fraction SABR in subgroups of patients remains controversial, including those with centrally located tumours, synchronous targets, proximity to dose-limiting organs at risk, and concomitant severe respiratory illness. This review provides an overview of the published randomised evidence evaluating single-fraction SABR in primary lung cancer and pulmonary oligometastases, the common clinical challenges faced, immunogenic effect of SABR, as well as technical and cost-utility considerations.