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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EStereotactic body radiation therapy (SBRT) is effective in patients with early-stage non\u2014small cell lung cancer (NSCLC) who are either medically inoperable or high-risk operable. This article discusses treatment approaches and considerations for the use of SBRT in this population.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiation Therapy\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiation Therapy\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EStereotactic body radiation therapy (SBRT) is effective in patients with early-stage non-small cell lung cancer (NSCLC) who are either medically inoperable or high-risk operable. Krzysztof Konopa, MD, Medical University of Gdansk, Gdansk Poland, discussed treatment approaches and considerations for the use of SBRT in this population.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe standard of care for patients with early-stage NSCLC is surgical resection; however, more than 20% of patients cannot undergo surgery due to comorbidities, and 30% of patients do not undergo surgery in the United States [Cykert S et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESBRT is effective in patients with medically inoperable NSCLC. In a Phase 2 trial of patients with inoperable NSCLC, the 3-year estimated overall survival (OS) rate was 59.5%, and the lung cancer-specific survival rate was 88.4% [Baumann P et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2009]. In the Radiation Therapy Oncology Group (RTOG) 0236 Phase 2 trial of patients with inoperable NSCLC, OS was more than 50% and disease-free survival (DFS) was about 50% [Timmerman R et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2010]. Similarly, in the medically inoperable arm of the Japan Clinical Oncology Group (JCOG) 0403 Phase 2 trial, the 3-year OS rate was 59.9% (95% confidence interval [CI], 51.4% to 67.5%), and the 3-year local control rate was 88% [Nagata Y et al. \u003Cem\u003EInt J Radiat Oncol Biol Phys\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESBRT may also be effective in patients who have early-stage NSCLC and are at high risk for surgery. In a retrospective study comparing SBRT to wedge resection, OS was greater in patients who underwent wedge resection, whereas SBRT resulted in better local control and freedom from failure [Grills IS et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2010]. In a population-based matched-pair comparison, OS was greater in patients who received SBRT until about 24 months; OS was greater at 36 months in patients who underwent resection [Palma D et al. \u003Cem\u003ERadiother Oncol\u003C\/em\u003E 2011]. In another retrospective study, SBRT resulted in improved OS compared with surgery, but regional control and cancer-specific survival were similar among both arms [Robinson CG et al. \u003Cem\u003EJ Thorac Oncol\u003C\/em\u003E 2013]. A Surveillance, Epidemiology, and End Results (SEER)-Medicare retrospective analysis found that the rate of OS was greatest in patients who underwent lobectomy, followed by sublobar resection, SBRT, conventional radiation, and no treatment [Shrivani SM et al. \u003Cem\u003EInt J Radiat Oncol Biol Phys\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProf. Konopa stated these data indicate that the efficacy of SBRT is consistent among studies, with 3-year rates of tumor control of 85% to 90%, rates of OS of 50% to 60% in medically inoperable patients, and 76% for high-risk operable patients.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPatients with large NSCLC tumors also benefit from SBRT. In a retrospective analysis, patients with stage T2 to T4 NSCLC with a planned target volume (PTV) of \u2264106 demonstrated a significant increase in local failure-free survival compared with patients with a PTV \u0026gt;106 (log-rank p=0.05). However, there is a risk of symptomatic pneumonitis, particularly in patients with an internal target volume (ITV) of \u2265145 cc, and those who receive a contralateral mean lung dose of \u22653.6 Gy [Bongers EM et al. \u003Cem\u003ERadiother Oncol\u003C\/em\u003E 2013]. Dr. Konopa stated that although SBRT for large tumors appears to be effective for local control, there is still a risk of distant failures and symptomatic pneumonitis. Therefore, additional studies are needed to determine if SBRT is beneficial in this population.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf. Konopa stated he thinks the data suggest that SBRT should be standard therapy for medically inoperable NSCLC, and it is comparable to surgery in patients with early-stage NSCLC who are considered at high risk for surgery, such as elderly patients.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/3\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpb11\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}