Can stereotactic fractionated radiation therapy become the standard of care for early stage non-small cell lung carcinoma.

Management of early stages non-small cell lung carcinoma has traditionally been surgery with radiation selected for medically inoperable patients. Recent emergence of stereotactic body radiation therapy allows for delivery of high radiation dose to the tumor while sparing normal lungs. This reviews compares loco-regional control, survival and complications rates between these two treatment modalities. Literature search identifies studies with stereotactic body radiation therapy and surgery for early stages non-small cell lung cancer. Effectiveness and toxicity of these two modalities was assessed. Stereotactic body radiation therapy is associated with minimal morbidity and provides comparable local control and survival in patients with multiple co-morbidities factors. Stereotactic body radiation therapy may become standard of care for operable early stages non-small cell lung cancer.

[1]  D. Harpole,et al.  Thoracoscopic Lobectomy Is a Safe and Versatile Procedure: Experience With 500 Consecutive Patients , 2006, Annals of surgery.

[2]  M. Hoogeman,et al.  Four-dimensional Stereotactic Radiotherapy for Early Stage Non-Small Cell Lung Cancer: A Comparative Planning Study , 2008, Technology in cancer research & treatment.

[3]  Matthias Guckenberger,et al.  Pulmonary injury and tumor response after stereotactic body radiotherapy (SBRT): results of a serial follow-up CT study. , 2007, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[4]  D. Wood,et al.  Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial. , 2006, The Annals of thoracic surgery.

[5]  W. Walker,et al.  Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[6]  E Brian Butler,et al.  Versatility of the Novalis System to Deliver Image-Guided Stereotactic Body Radiation Therapy (SBRT) for Various Anatomical Sites , 2007, Technology in cancer research & treatment.

[7]  L. Leksell The stereotaxic method and radiosurgery of the brain. , 1951, Acta chirurgica Scandinavica.

[8]  Ping Li,et al.  Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer. , 2006, International journal of radiation oncology, biology, physics.

[9]  K. Johansson,et al.  Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer--mature results for medically inoperable patients. , 2006, Lung cancer.

[10]  J. Beitler,et al.  Stereotactic body radiation therapy for nonmetastatic lung cancer: an analysis of 75 patients treated over 5 years. , 2006, International journal of radiation oncology, biology, physics.

[11]  Branislav Jeremic,et al.  Stereotactic hypofractionated radiation therapy for stage I non-small cell lung cancer. , 2005, Lung cancer.

[12]  E. Glatstein,et al.  Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer , 2008 .

[13]  Y. Sakao,et al.  Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma. , 2007, Interactive cardiovascular and thoracic surgery.

[14]  Masahiro Hiraoka,et al.  Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. , 2005, International journal of radiation oncology, biology, physics.

[15]  M. Nishimura,et al.  Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas , 2002, Cancer.

[16]  Angelika Hoess,et al.  Stereotactic single‐dose radiotherapy (radiosurgery) of early stage nonsmall‐cell lung cancer (NSCLC) , 2007, Cancer.

[17]  R. Lewis,et al.  Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy: a more patient-friendly oncologic resection. , 1999, Chest.

[18]  R. Mckenna,et al.  Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. , 2006, The Annals of thoracic surgery.

[19]  A. Watanabe,et al.  Assessment of node dissection for clinical stage I primary lung cancer by VATS. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[20]  J. Fowler,et al.  Lung Metastases Treated by CyberKnife® Image-Guided Robotic Stereotactic Radiosurgery at 41 Months , 2008, Southern medical journal.

[21]  L V Rubinstein,et al.  Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. , 1995, The Annals of thoracic surgery.

[22]  A. Yim,et al.  Thoracoscopic major lung resections: an Asian perspective. , 1998, Seminars in thoracic and cardiovascular surgery.

[23]  Yoshihiro Takai,et al.  A phase II study on stereotactic body radiotherapy for stage I non-small cell lung cancer. , 2007, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[24]  T. Shinkai,et al.  Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer , 2007, Surgical Endoscopy.

[25]  Lester D. Boeh,et al.  Trilogy image-guided stereotactic radiosurgery. , 2007, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[26]  A. Sihoe,et al.  Video-assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function. , 2006, The Annals of thoracic surgery.

[27]  Jan Nyman,et al.  Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries , 2006, Acta oncologica.

[28]  W. Mühlnickel,et al.  Stereotactic, high single-dose irradiation of stage I non-small cell lung cancer (NSCLC) using four-dimensional CT scans for treatment planning. , 2008, Lung cancer.

[29]  D. Sugarbaker,et al.  Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. , 2005, Chest.

[30]  E. Smit,et al.  Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. , 2008, International journal of radiation oncology, biology, physics.

[31]  M. Anscher,et al.  Radiotherapy alone for medically inoperable stage I non-small-cell lung cancer: the Duke experience. , 1998, International journal of radiation oncology, biology, physics.

[32]  F. Sebag,et al.  VATS is an adequate oncological operation for stage I non-small cell lung cancer. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[33]  R. Timmerman,et al.  FDG-PET and stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer. , 2005, Lung cancer.

[34]  Hideo Kawaguchi,et al.  Clinical outcome of stereotactic body radiotherapy of 54 Gy in nine fractions for patients with localized lung tumor using a custom-made immobilization system , 2007, Radiation Medicine.

[35]  R. Kratzke,et al.  Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. , 2007, The Annals of thoracic surgery.

[36]  R. Bueno,et al.  Thoracoscopic surgery in elderly lung cancer patients. , 2004, Critical reviews in oncology/hematology.

[37]  M. Okumura,et al.  Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: a multi-institutional study. , 2006, The Journal of thoracic and cardiovascular surgery.

[38]  Hiroshi Onishi,et al.  Clinical outcomes of stereotactic radiotherapy for stage I non-small cell lung cancer using a novel irradiation technique: patient self-controlled breath-hold and beam switching using a combination of linear accelerator and CT scanner. , 2004, Lung cancer.

[39]  P. Pairolero,et al.  Lung cancer in octogenarians: factors affecting long-term survival following resection. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[40]  Xiaodong Wu,et al.  Treatment of Early Non-Small Cell Lung Cancer, Stage IA, by Image-Guided Robotic Stereotactic Radioablation—CyberKnife , 2007, Cancer journal.

[41]  M. Hiratsuka,et al.  Video-assisted thoracoscopic surgery lobectomy for c-T1N0M0 primary lung cancer: its impact on locoregional control. , 2006, The Annals of thoracic surgery.

[42]  J. Bradley,et al.  Elective nodal failures are uncommon in medically inoperable patients with Stage I non-small-cell lung carcinoma treated with limited radiotherapy fields. , 2003, International journal of radiation oncology, biology, physics.

[43]  F. di Francesco,et al.  Video-assisted thoracic surgery major pulmonary resections. Present experience. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[44]  I. Lax,et al.  Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. , 1994, Acta oncologica.

[45]  Hiroki Shirato,et al.  STEREOTACTIC RADIATION THERAPY WORKSHOP Hypofractionated Stereotactic Radiotherapy (HypoFXSRT) for Stage I Non-small Cell Lung Cancer: Updated Results of 257 Patients in a Japanese Multi-institutional Study , 2007 .

[46]  Cristiano Feijó Andrade,et al.  Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória , 2006 .

[47]  K. Esato,et al.  Video-assisted Thoracoscopic Lobectomy Achieves a Satisfactory Long-term Prognosis in Patients with Clinical Stage IA Lung Cancer , 2000, World Journal of Surgery.

[48]  M. Hiraoka,et al.  Stereotactic body radiation therapy (SBRT) for early-stage lung cancer. , 2007, Cancer Radiothérapie.

[49]  D. Sugarbaker,et al.  Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[50]  T. Naruke,et al.  Is major pulmonary resection by video-assisted thoracic surgery an adequate procedure in clinical stage I lung cancer? , 2004, Chest.

[51]  E. Kunieda,et al.  Possible misinterpretation of demarcated solid patterns of radiation fibrosis on CT scans as tumor recurrence in patients receiving hypofractionated stereotactic radiotherapy for lung cancer. , 2008, International journal of radiation oncology, biology, physics.

[52]  M. Tsuchida,et al.  Surgical strategy for clinical stage I non-small cell lung cancer in octogenarians. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[53]  Hiroshi Honda,et al.  Breath-hold monitoring and visual feedback for radiotherapy using a charge-coupled device camera and a head-mounted display: system development and feasibility , 2008, Radiation Medicine.

[54]  N. Nishiumi,et al.  Usefulness of video-assisted thoracic surgery (Two Windows Method) in the treatment of lung cancer for elderly patients. , 1999, Journal of Cardiovascular Surgery.

[55]  R. T. Ten Haken,et al.  Long-term results of high-dose conformal radiotherapy for patients with medically inoperable T1-3N0 non-small-cell lung cancer: is low incidence of regional failure due to incidental nodal irradiation? , 2006, International journal of radiation oncology, biology, physics.

[56]  M. Gulisano,et al.  Relevance of biologically equivalent dose values in outcome evaluation of stereotactic radiotherapy for lung nodules. , 2008, International journal of radiation oncology, biology, physics.

[57]  M. Scorsetti,et al.  Effectiveness of stereotactic body radiotherapy in the treatment of inoperable early-stage lung cancer. , 2007, Anticancer research.

[58]  D. Petsikas,et al.  What keeps postpulmonary resection patients in hospital? , 2003, Canadian respiratory journal.

[59]  M. Underwood,et al.  Video-assisted thoracic surgery lobectomy for lung cancer is associated with less immunochemokine disturbances than thoracotomy. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[60]  G. Roviaro,et al.  Long-term survival after videothoracoscopic lobectomy for stage I lung cancer. , 2004, Chest.

[61]  D. Libby,et al.  Tumor size predicts survival within stage IA non-small cell lung cancer. , 2003, Chest.

[62]  Y. Onodera,et al.  Steep dose-response relationship for stage I non-small-cell lung cancer using hypofractionated high-dose irradiation by real-time tumor-tracking radiotherapy. , 2008, International journal of radiation oncology, biology, physics.

[63]  J. Loscertales,et al.  Video-assisted thoracic surgery (VATS) lobectomy: 13 years’ experience , 2008, Surgical Endoscopy.

[64]  V. Seshan,et al.  Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. , 2008, The Annals of thoracic surgery.

[65]  Luís Bragança,et al.  A methodological approach , 2005 .

[66]  Stereotactic Body Radiation Therapy for Early Non-Small Cell Lung Cancer: Experience at the University of Turin , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[67]  A. Iwasaki,et al.  Results of video-assisted thoracic surgery for stage I/II non-small cell lung cancer. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[68]  Koichi Yamazaki,et al.  Histopathologic consideration of fiducial gold markers inserted for real-time tumor-tracking radiotherapy against lung cancer. , 2008, International journal of radiation oncology, biology, physics.

[69]  F. Gharagozloo,et al.  Video-assisted thoracic surgery lobectomy for stage I lung cancer. , 2003, The Annals of thoracic surgery.

[70]  G. Varela,et al.  Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[71]  C. F. Andrade,et al.  Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality. , 2006, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[72]  M. Hiraoka,et al.  A Japan clinical oncology group trial for stereotactic body radiation therapy of non-small cell lung cancer. , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[73]  G. Watanabe,et al.  Surgical results in T2N0M0 nonsmall cell lung cancer patients with large tumors 5 cm or greater in diameter: what regulates outcome? , 2006, The Annals of thoracic surgery.

[74]  Arthur L Boyer,et al.  Respiratory gated beam delivery cannot facilitate margin reduction, unless combined with respiratory correlated image guidance. , 2008, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[75]  M. Mack,et al.  Lobectomy--video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. , 1995, The Journal of thoracic and cardiovascular surgery.

[76]  J. Fowler The first James Kirk memorial lecture. What next in fractionated radiotherapy? , 1984, The British journal of cancer. Supplement.

[77]  K. Sheng,et al.  Dose as a function of lung volume and planned treatment volume in helical tomotherapy intensity-modulated radiation therapy-based stereotactic body radiation therapy for small lung tumors. , 2007, International journal of radiation oncology, biology, physics.

[78]  W. Geis,et al.  Major thoracic surgery in octogenarians , 2003, Surgical Endoscopy And Other Interventional Techniques.

[79]  M. Okada,et al.  Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection. , 2005, The Journal of thoracic and cardiovascular surgery.