Previous SBRT: Repeat SBRT may be feasible in a highly selected patient population and is a highly individualized decision. Very limited data exist for this subset of patients. Radiation oncologists should carefully assess evidence-based patient, tumor and treatment factors before initiating treatment, as toxicity implications of repeat SBRT are important.
Previous sublobar/limited resection: As with repeat SBRT in other disease scenarios, limited data exist on the use of SBRT following limited surgical resections; SBRT may be feasible, but treating physicians should carefully weigh patient and disease characteristics on an individual basis.
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"With longer life expectancies and more sophisticated diagnostic tools, we have seen a rise in the incidence of early-stage lung cancer, including among patients who are not able to undergo surgery or choose not to do so. SBRT provides an option for these patients, who otherwise may not have received curative, definitive treatment," said Gregory M. M. Videtic, MD, co-chair of the task force that authored the guideline and a radiation oncologist at the Cleveland Clinic. "Increasing access to this potentially life-saving treatment is essential to improve outcomes for the growing population of early-stage NSCLC patients."
"NSCLC is a complex disease, with a great deal of heterogeneity among patients. This guideline reinforces SBRT as the standard of care for medically inoperable patients, but it also examines the safety and efficacy of SBRT in less traditional clinical scenarios, such as patients with larger tumors or recurrent patients with early-stage disease," said Megan E. Daly, MD, also co-chair of the task force and a radiation oncologist at the University of California, Davis in Sacramento, California.
The guideline was based on a systematic literature review of studies published from January 1995 through August 2016. A total of 402 abstracts were retrieved from PubMed, and the 172 articles that met inclusion criteria were evaluated by an 18-member task force of experts in lung cancer, including radiation oncologists, surgeons and a patient representative. The Clinical Practice Statement was approved by ASTRO's Board of Directors following a period of public comment. The guideline has been endorsed by the International Association for the Study of Lung Cancer (IASLC), the European Society for Radiotherapy & Oncology (ESTRO) and the Royal Australian and New Zealand College of Radiologists (RANZCR).
