Stereotactic Radiotherapy Standard of Care for Frail Patients with Early-Stage Lung Cancer

Stereotactic body radiation therapy (SBRT) should be considered a new standard of care for early-stage lung cancer treatment in patients with coexisting medical problems, according to results from a U.S. clinical trial.

In this study, 55 patients diagnosed with early non-small-cell lung (NSCL) cancer and unable to have their tumors surgically removed because of unrelated medical comorbidities were treated with SBRT during three noninvasive outpatient treatments.

The most recent findings, presented by researchers from University of Texas (UT) Southwestern Medical Center (Dallas, USA) in Chicago, IL, USA, in early November 2009 at the 51st annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), revealed that the primary lung cancer did not recur 98% of the time. In spite of their extreme frailty, more than half of these patients--56%--were living three years after diagnosis, while less than 20% ultimately died of metastatic lung cancer.

"These findings have changed the standard of care for lung cancer in patients with serious medical problems like emphysema, heart disease and strokes,” said Dr. Robert Timmerman, vice chairman of radiation oncology at UT Southwestern and principal investigator of the Radiation Therapy Oncology Group (RTOG) 0236 study.

SBRT delivers multiple high-dose radiation beams to a tumor in a concentrated, very precise manner. Each of these beams is relatively weak and causes very little damage when traveling through the patient's body, but when all the beams converge at the target, their cumulative effect delivers an extremely potent dose aimed at destroying the target cells with great precision.

"Despite the high potency of the treatment, less than 20% of these extremely frail patients experienced a serious health decline,” said Dr. Timmerman, considered one of the top international experts on stereotactic radiotherapy.

Dr. Timmerman reported that the study results were better than researchers had expected and are similar to the risks for healthier patients who undergo radical surgery--the standard treatment for early-stage NSCL cancer for the past century. "The findings support the ongoing clinical research in healthier patients who currently undergo surgery for early-stage NSCL cancer,” Dr. Timmerman said. "SBRT is fast, convenient and very effective.”

Dr. Timmerman and his team, hoping to find out if the treatment indications might be expanded in a new trial, are now conducting clinical studies using SBRT in healthier patients who would otherwise be candidates for surgery.

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University of Texas Southwestern Medical Center