Radiosurgery: Will it Replace Surgery?

What You Need to Know: Stereotactic Body Radiation Therapy (SBRT) is an effective alternative to surgery for medically inoperable aptients with early lung cancer.

What is Radiosurgery? 

The Evidence: The Radiation Therapy Oncology Group (RTOG; USA) 0236 trial enrolled 59 patients with early (T1 and T2) peripheral lung cancer. Here are the results at 3 years:

  • Local tumor control: 97.6%
  • Overall survival 56%
  • Local tumor control, including for the entire lobe: 90.6%
  • Side effects: Grade 3 = 13%; Grade 4 = 3.6%; more patients died of other causes than they did from lung cancer
  • My Take: This provocative study suggests that highly selected patients with early lung cancer may now have an effective, non-invasive management tool. However, we do not have high-level evidence to have it replace surgery. For now, it offers great promise for patients deemed to infirm (medically inoperable) for surgery. Unfortunately only two prospective trials have been reported for operable patients – and remain unpublished.
  • Several randomized studies comparing surgery to stereotactic body radiation therapy (Stereotactic Ablative Body Radiation, or SABR) have close early due to poor accural, including ROSEL (lobectomy vs. SBRT), STARS (lobectomy vs. SBRT with cyberknife), and ACOSOG Z4099/RTOG 1021 (sublobar resection vs. SBRT). I’m Dr. Michael Hunter.
  • Patients with centrally located tumors may be treated effectively with SBRT, but are at higher risk fo side effects. In addition, larger tumors may not have the same high local control rates as do smaller ones.

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

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