Stereotactic ablative radiation therapy for the treatment of early stage non-small-cell lung cancer: CEPO review and recommendations
S'appuyant sur une revue de la littérature publiée jusqu'en décembre 2013 (44 articles), un groupe d'experts canadiens présente ses recommandations en matière de radiothérapie stéréotaxique ablative pour traiter un cancer du poumon non à petites cellules de stade précoce
Résumé en anglais
Background : Lung cancer is the second most diagnosed cancer and the leading cause of cancer-related mortality in Canada. Surgical resection is the treatment of choice for patients with stage I non-small-cell lung cancer (NSCLC). However, 20 % to 30 % of them are deemed medically inoperable and may be offered radiation therapy. Standard external-beam radiation therapy is associated with high rates of local recurrence and poor long-term survival. Stereotactic ablative radiation therapy (SABR) is increasingly being proposed for inoperable patients, and the use of this treatment modality for operable patients is also being contemplated. The objective of this guideline is to review the efficacy and safety of SABR in these two clinical situations and to develop evidence-based recommendations.
Method : A review of the scientific literature published up to December 2013 was performed. A total of 44 publications were included.
Recommendations : Considering the evidence available to date, the Comite de l'evolution des pratiques en oncologie (CEPO) recommends: 1) for medically operable patients with stage T1-2N0M0 NSCLC, that surgery remain the standard treatment, since comparative data regarding the efficacy of SABR and surgery are currently insufficient for SABR to be considered an equivalent alternative to surgery for these patients; 2) for medically inoperable patients with stage T1-2N0M0 NSCLC or medically operable patients who refuse surgery, that SABR be preferred to standard external-beam radiotherapy (grade B recommendation); 3) that the biological equivalent dose (BED10) used for SABR treatment be at least 100 Gy (grade B recommendation); 4) for patients with a central tumour, a large-volume tumour (large planning target volume) or severe pulmonary comorbidity, that a risk-adaptive schedule be used (dose reduction or increase in the number of fractions; grade B recommendation); 5) that the choice of using SABR for treatment be discussed within tumour boards; treatment with SABR (or with standard external-beam radiotherapy) should not be considered for patients whose life expectancy is very limited due to comorbidities (grade D recommendation).
