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With about 1200 cases each year, lung cancer is the fourth most common cause of cancer in Western Australia, but the number one cause of cancer death.


With about 1200 cases each year, lung cancer is the fourth most common cause of cancer in Western Australia, but the number one cause of cancer death.

Dr Tee Lim
MBBS, FRANCR
Radiation Oncologist, GenesisCare

However, 20% of patients with potentially curable stage I NSCLC at diagnosis are not suitable for surgery due to poor lung function or medical comorbidities, and some patients decline surgery. The National Comprehensive Cancer Network (NCCN) and the American College of Chest Physicians recommend that all patients with NSCLC be evaluated by a multidisciplinary team to determine operability.

CASE EXAMPLE
Highly avid 33mm left upper lobe lung cancer on PET scan before SABR in an elderly patient

Treatment plan:
Four fractions over four days

Six months post SABR: complete metabolic response on PET scan. Patient remained disease-free and well at 33-months of follow-up

SABR – a comparable option to surgery in selected patients 

Data has shown that stereotactic ablative body radiation therapy (SABR) achieves comparable local control and survival as surgery in patients with early-stage NSCLC. Today, it is considered standard curative treatment for medically inoperable early-stage non-small cell lung cancer or for those who refuse surgery (NSCLC).

Whether it is an appropriate treatment for patients who are candidates for surgery remains, however, controversial. Currently, there are multicentre, randomised controlled trials (STABLE-MATES, VALOR, and POSTILV) underway to compare surgical resection and SABR in patients with early-stage lung cancer.  An additional UK trial (SABRTooth) has recently closed recruitment. The results are yet to be published.  

What is SABR?
  • Extremely precise, SABR uses advanced image guidance to deliver high doses of radiation to the target in 1-5 treatment sessions whilst avoiding surrounding healthy tissue.
  • SABR is non-invasive and associated with relatively few treatment-related complications.
  • Advanced age is not a barrier to treatment – it is well tolerated in elderly and frail patients.
  • Delivery is via either advanced linear accelerator-based machines or CyberKnife®. Both produce comparable treatment outcomes and toxicities in early-stage NSCLC.  
  • In 2010, GenesisCare Wembley was the one of the first centres in Australia, and the first centre in Western Australia, to implement SABR in early-stage NSCLC.

 

– References available upon request

Questions? Contact the editor.

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