title: Management of early-stage non-small cell lung cancer using stereotactic ablative radiotherapy: controversies, insights, and changing horizons.
abstract: The use of stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer is growing rapidly, particularly since it has become the recommended therapy for unfit patients in current European and North American guidelines. As three randomized trials comparing surgery and SABR closed prematurely because of poor accrual, clinicians are faced with a dilemma in individual patient decision-making. Radiation oncologists, in particular, should be aware of the data from comparative effectiveness studies that suggest similar survival outcomes irrespective of local treatment modality. The necessity of obtaining a pathological diagnosis, particularly in frail patients prior to treatment remains a challenge, and this topic was addressed in recent European recommendations. Awareness of the high incidence of a second primary lung cancer in survivors, as well as other competing causes of mortality, is needed. The challenges in distinguishing focal scarring from recurrence after SABR also need to be appreciated by multidisciplinary tumor boards. With a shift in focus toward patient-centered decision-making, clinicians will need to be aware of these new developments and communicate effectively with patients, to ensure that treatment decisions are reflective of patient preferences. Priorities for additional research in the area are proposed.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands; Department of Radiation Oncology, University of Western Ontario, London, Canada; Department of Epidemiology, Harvard University, Boston, USA. Electronic address: dr.alexlouie@gmail.com.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Louie
authors.affiliation: Department of Radiation Oncology, University of Western Ontario, London, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Palma
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Dahele
authors.affiliation: Department of Radiation Oncology, University of Western Ontario, London, Canada.
authors.forename: George B
authors.initials: GB
authors.lastname: Rodrigues
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
keywords: Comparative effectiveness; Lung cancer; Stereotactic ablative radiotherapy