Stereotactic body radiotherapy (SBRT) in NSCLC

Matthias Guckenberger, MD of University Hospital Zurich, Switzerland discusses his talk on Stereotactic Body Radiotherapy (SBRT) at the 2016 World Conference of Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer (IASLC) in Vienna, Austria. He talks about its use for early stage non-small cell lung cancers (NSCLC) as a curative approach, and its use for more advanced stage disease (oligometastatic disease) and its use for patients with brain metastases. SBRT has become the guideline recommended treatment for inoperable patients with early stage NSCLC. Investigations in the last few years have looked at expanding the indications for SBRT patients who are even sicker, patients cohorts with comorbidities, or patients who have not been offered any curative treatment before. It was difficult to observe patients with comorbidities or older patients who would not benefit from SBRT. SBRT is very well-tolerated due to its precision. As a result of this, his department offer all patients SBRT as a curative approach even if they are old or have many comorbidities. Looking at less fragile patients, three randomized control trials have looked at how SBRT compared to the standard of surgery and standard of lobectomy. These trials were unsuccessful. Pooling results from two of these trials showed that SBRT is not worse but equivalent to what is seen in surgery and even better tolerated. This gives support and indication that SBRT might extend into the operable patient core. Trials in the last few years have compared overall survival (OS) in surgical cohorts using prospective and retrospective analysis with patients treated with SBRT and who were fit for surgery but had refused. Future trials will address this comparison but currently results appear to show they are similar.