Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor: A new paradigm?

Abstract

Stereotactic ablative body radiotherapy (SABR) is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer (NSCLC) and pulmonary metastasis. Several fractionation schemes have proven to be safe and effective, including the single fraction (SF) scheme. SF is an option cost-effectiveness, more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments. The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm, recommending this option to minimize patients’ visits to hospital. SF SABR already has a long experience, strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases, making it a valid treatment option; although its use in central locations, synchronous and recurrencies tumors requires more prospective safety and efficacy studies. The SABR radiobiology study, together with the combination with systemic therapies, (targeted therapies and immunotherapy) is a direction of research in both advanced disease and early stages whose future includes SF.

Keywords: Stereotactic body radiotherapy, Sterotactic ablative body radiotherapy, Radiosurgery, Non-small cell lung cancer, Lung cancer, Lung metastases

Core Tip: There is strong evidence (two phase II prospective studies) to support using single-fraction stereotactic ablative body radiotherapy schemes in early stage peripheral non-small cell lung cancer. In pulmonary oligometastatic disease, there are promising outcomes and publication of one randomized prospective phase II study is pending. The association of this scheme with new systemic therapies looks promising for the future.