WCLC 2019 – Stereotactic ablative radiotherapy as a curative option for synchronous early-stage NSCLC

  • Cristina Ferrario — Agenzia Zoe
  • Univadis
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  • Stereotactic ablative radiotherapy (SABR) represent a potentially curative approach for synchronous early-stage non-small cell lung cancers (NSCLC) and should be considered in the management of these patients.
  • The toxicity is minimal and the dominant pattern of failure is distant metastases.

Why this matters

  • In multifocal lung cancer it is challenging to determine whether the lesions represent separate primary tumours or intrapulmonary metastases.
  • A safe and effective treatment is needed.
  • Local treatment options include surgery, but a significant proportion of patients with these cancers are not ideal surgical candidates.

Study design

  • Retrospective review of patients diagnosed with synchronous early-stage NSCLC treated with SABR for at least one lesion between 2005 and 2015.
  • As by definition, synchronous lesions were multiple ipsilateral or contralateral intrapulmonary lesions diagnosed within 6 months.
  • The study aimed to determine the efficacy and patterns of failure of SABR as a treatment for early-stage synchronous NSCLC.

Key results

  • 82 (9%) of the 912 patients treated with SABR had a synchronous disease, for a total of 169 lesions.
  • At a median follow-up time of 58 months, progression-free survival rates were 85.4%, 47.3% and 28.5%, at 1, 3 and 5 years, respectively.
  • Overall survival rates were 95.1%, 66.9% and 52.4% respectively, while local recurrence (LR)-free survival rates were 97.3%, 79.6% and 70.8%.
  • 39 (4.28%) patients had disease progression.
  • Distant failure and isolated regional recurrence occurred in 25.6% and 3.7% of patients, respectively.
  • No grade 3-4 acute/late toxicities were found in terms of radiotherapy pneumonitis, chest wall pain, skin toxicity, esophagitis and brachial plexopathy.

Expert commentary

“The study showed that SABR provides excellent local control without severe complication in early-stage lung cancer. Multifocal synchronous lung cancer can be good candidates for SABR”. Samina Park. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea.