Radiotherapy with curative intent in patients with early stage, medically inoperable, non-small cell lung cancer: A Systematic Review

• Published in: Clinical lung cancer Vol. 18; no. 2; pp. 105 - 121.e5
• Main Authors: Falkson, Conrad B., MBChB, Vella, Emily T., PhD, Yu, Edward, MD, PhD, El-Mallah, Medhat, MBBCh, M.Sc, Ph.D, FRCPC, PhD, Mackenzie, Robert, MS, Ellis, Peter M., MBBS, PhD, Ung, Yee C., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Dose fractionation; Hematology, Oncology and Palliative Medicine; Humans; Hypofractionation; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Neoplasm Staging; NSCLC; Prognosis; Pulmonary/Respiratory; Stereotactic ablative radiation therapy; Stereotactic body radiation therapy; non-small cell lung cancer; stereotactic body radiation therapy; stereotactic ablative radiation therapy; systematic review; inoperable; early stage; Hypofractionation; Stereotactic body radiation therapy; Dose fractionation; NSCLC; Stereotactic ablative radiation therapy
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2016.10.008

Abstract Introduction Patients with early stage non-small cell lung cancer (NSCLC) who are unable to undergo surgery may be offered radiation therapy (RT). Previously, conventional RT was offered; however, newer techniques such as stereotactic body radiation therapy (SBRT) have become available. The objective of this systematic review was to investigate the effectiveness of radiotherapy with curative intent in patients with early stage NSCLC who are medically inoperable. Methods MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing stereotactic radiation treatment with curative intent compared with observation or other types of radiotherapy for early stage, medically inoperable, NSCLC. Comparisons between radiation dosing or fractionation schedules for SBRT were included. Results Four systematic reviews and 52 observational studies were included. The evidence suggests that SBRT compared with observation or other forms of radiotherapy treatments such as accelerated hypofractionated RT, three-dimensional conformal radiotherapy, conventional fractionated RT, external beam RT, proton beam therapy, and carbon ion therapy may have similar or improved results in survival or local control with similar or fewer adverse effects. Evidence also suggests that local tumour control and survival was associated with the BED for SBRT. Several studies suggested a cut-off of approximately 100 BED was significantly correlated with patient outcomes. Conclusion This evidence suggests that SBRT compared with other forms of radiotherapy is a reasonable treatment option for patients with medically inoperable early stage NSCLC.