Stereotactic Radiotherapy Can Be a Great Option for Early-Stage Lung Cancer

Surgery for lung cancer is an invasive procedure designed to entirely remove the tumor and surrounding lymph nodes to ensure no tumor cells are left behind. Typically, the entire involved lobe of the lung is removed (called a lobectomy) to ensure the tumor has been resected. In more rare cases surgery may consist of either removing less than one lobe or even the entire lung. However, most patients will have a lobectomy to treat their lung cancer.

In patients who are not able to have surgery or who elect not to have surgery, there is an excellent non-invasive alternative known as Stereotactic Body Radiotherapy or SBRT. SBRT has local control rates similar to surgical resection and is an excellent option if you or a loved one has been told you are not a candidate for surgery.

RELATED: Overview of Radiation Therapy for Stage 3 Lung Cancer

Who may not be a candidate for surgery?

Surgery is invasive and typically removes an entire lobe of the lung. Before surgery patients will undergo extensive testing to ensure they are healthy enough to tolerate the surgery and that they will have enough lung capacity following surgery to live a functional life. Some tests your doctor may order include an echocardiogram, extensive blood work, pulmonary function testing (PFTs), and several others. The results of these tests will help guide the doctor's decision and determine if someone is a good candidate for surgery. Many other factors are quite nuanced when deciding who is healthy enough for surgery and are beyond the scope of this article. Our best advice is to go to an NCI-designated center with an experienced surgical team to ensure you’re getting the best care.

In some circumstances, patients may wish to avoid the toxicity and invasiveness of surgery and have SBRT. SBRT can be an excellent choice for these patients as long as they are fully counseled on the risks and benefits of electing SBRT over surgery.

What is SBRT?

Stereotactic ablative radiotherapy, known as SABR or SBRT, is a form of radiation treatment that focuses very precise, very intense doses of high-energy beams onto cancer cells. This kills the cancer while reducing the potential damage to healthy tissue surrounding it.

Only patients with small, early-stage lung cancer are good candidates for SBRT. Ahead of the treatment, a scan determines the three-dimensional location of your tumor. The treatment is then delivered through devices called linear accelerators, which form high-energy beams.

“The advantage of getting SBRT instead of traditional radiation therapy is that it has fewer side effects and better outcomes”

says Dr. Billy Loo, an Associate Professor of Radiation Oncology at Stanford University Medical Center. Dr. Loo says the most common side effects are tiredness and fatigue, although these don't affect the majority of patients. SBRT can also be done in five or fewer sessions, whereas traditional radiation therapy can take weeks.

Additionally, radiation is non-invasive and requires no hospital stay. The treatment is typically delivered every other day over two weeks and takes about 20 minutes each day. Patients have no restrictions on their lives and can go about their lives as normal during treatment. After treatment with SBRT, similar to surgery, patients are followed with CT scans and other imaging studies to ensure the tumor does not return.

What are the outcomes of SBRT?

SBRT is an excellent alternative to surgery and has similar rates of local control compared with surgery. The delivery of SBRT has significantly improved over the past several years. These advances have allowed larger doses of radiation to be safely delivered to tumors increasing the effectiveness of this treatment option. Because SBRT has significantly improved over the prior years there is debate among oncologists questioning if surgery should remain the standard of care or if SBRT should be considered an equally effective alternative even in people healthy enough to have surgery. This debate has led to the development of a large national clinical trial that is currently randomizing healthy individuals (healthy enough for surgery) between surgery and SBRT for definitive management of their early-stage lung cancer.

We bring this up to provide hope for patients that are told they are unable to have surgery. Hearing this is not a reason to lose hope as many oncologists believe SBRT is equally as effective or even better for treating early-stage lung cancer. However, until the results of this trial are known surgery remains the standard of care for medically operable patients and SBRT serves as an excellent alternative.

The take-home message.

Getting a cancer diagnosis can be overwhelming. Hearing you have lung cancer can be especially frightening but remain hopeful as treatment has significantly improved over the past several years. For early stage, lung cancer surgery remains the standard of care in patients who are healthy enough to have this procedure. For patients who are not healthy enough or who wish to avoid surgery SBRT is an excellent alternative.

If you or a loved one have been diagnosed with lung cancer we recommend seeking care at an experienced center where many similar patients are treated each year. Lung cancer treatment requires a multidisciplinary team including surgeons, medical oncologists, radiation oncologists, pulmonologists, and many others. As always be your own advocate and ask questions. If you feel uncomfortable with your treatment team it is always a good idea to seek a second opinion.

Early-stage lung cancer is curable and highly focused radiation using SBRT is one of many tools modern oncologists have in battling this disease.

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