Early-stage non-small cell lung cancer in elderly patients: Should stereotactic radiation therapy be the standard of care?

摘要

Ten years ago, the idea of delivering large hypofractionated doses of up to 20 Gy in a single session would have been a major departure from conventional radiation oncology teaching. Historically, most dose escalation studies for non-small cell lung cancer (NSCLC) respected the "4 Rs of radiobiology" and took the approach of adding additional once-daily fractions of 2 Gy, prolonging treatment time, and risking tumor repopulation. Stereo-tactic radiation therapy, referred to as SBRT or SABR, was a paradigm shift, breaking with radiobiology orthodoxy to deliver enormous doses in few fractions. SABR fractionation schemes were a cause for concern, particularly in light of predictions of late effects made by the imperfect linear-quadratic model, but SABR was nevertheless adopted with caution and careful assessment of potential side effects by pioneering groups in Japan, Europe, and North America.