“We believe SBRT provides a new and safe treatment option for patients whose tumor is highly suspicious of malignancy,” Dr. Atsuya Takeda from Ofuna Chuo Hospital, Japan told Reuters Health in an email. “When physicians find inoperable patients with solitary pulmonary nodule, we would like the physicians to consult with experts including respirologist, thoracic surgeon, diagnostic radiologist, and radiation oncologist. The possibility of malignancy and treatment strategy for such patients should be fully discussed.”
An earlier study from Japan showed SBRT to be effective in early stage non-small-cell lung cancer (NSCLC).
Dr. Takeda and colleagues compared outcomes of SBRT in 58 patients with solitary pulmonary nodules clinically diagnosed as lung cancer (CDLC) with those in 115 patients with pathologically confirmed NSCLC.
There were no significant differences between CDLC and NSCLC patients for the rates of 3-year local control (80% and 87%, respectively), regional-free survival (88% and 91%), metastasis-free survival (70% and 74%), progression-free survival (64% and 67%), cause-specific survival (74% and 71%), or overall survival (54% and 57%).
There was no acute toxicity during SBRT. Grade 2 radiation pneumonitis developed after SBRT in 12% of CDLC patients and 16% of NSCLC patients, and grade 3 radiation pneumonitis developed in 9% of CDLC patients and 3% of NSCLC patients.
There were no cases of grade 4 or 5 radiation pneumonitis or any other toxicities of grade 3 or above.
“Currently, for operable patients, lobectomy with mediastinal dissection is a standard therapy,” Dr. Takeda said. “SBRT can be an option for patients who refuse surgery.”
“We hope that more discussion on the optimal treatment strategy for inoperable patients with solitary pulmonary nodule will be raised to reach a consensus,” Dr. Takeda concluded. “We would like to emphasize that a careful attention is necessary in treating histologically unproven patients.”
Lung Cancer 31 January 2012