Abstract
Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.
Highlights
The standard treatment for metastatic disease has been with systemic therapy alone
Most studies have described in different ways the term Oligometastatic disease (OMD) as it has been defined with significant variation regarding the size and the number of lesions [22]
Inoperability encompasses serious comorbidities such as severe pulmonary hypertension; diabetes mellitus with end organ damage; cerebral vascular disease; severe chronic heart disease or severe cardiovascular disease [41,66,67] Stereotactic body radiation therapy (SBRT) is recommended as a treatment option for this population if they have an estimated life expectancy greater than 1 year [68]
Summary
The standard treatment for metastatic disease has been with systemic therapy alone. Budczies et al conducted a cohort study in 1008 postmortem patients, and the lung was the third most frequent site of metastases of 16 types of solid cancer [11]. Some authors consider it to be the second most frequent site [10,11] of metastatic target for neoplastic cells since it has a microenvironment that is rich in vascular supply, as well as containing small capillaries with a very short distance to the intravascular space [12]. The proliferation of metastatic foci is succeeded by the production of proangiogenic factors such as vascular endothelial growth factor, fibroblast growth factor, and interleukin-8 (IL-8) [14]
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