Abstract
Stereotactic ablative radiotherapy (SABR), a recent implementation in the practice of radiation oncology, has been shown to confer high rates of local control in the treatment of early stage non-small-cell lung cancer (NSCLC). This technique, which involves limited invasive procedures and reduced treatment intervals, offers definitive treatment for patients unable or unwilling to undergo an operation. The use of protons in SABR delivery confers the added physical advantage of normal tissue sparing due to the absence of collateral radiation dose delivered to regions distal to the target. This may translate into clinical benefit and a decreased risk of clinical toxicity in patients with nearby critical structures or limited pulmonary reserve. In this review, we present the rationale for proton-based SABR, principles relating to the delivery and planning of this modality, and a summary of published clinical studies.
Highlights
Non-small-cell lung cancer (NSCLC) in its early stage can be treated definitively with favorable outcomes
stereotactic ablative radiotherapy (SABR) is defined as a “high dose of radiation to an extracranial target in the body using either a single dose or a small number of fractions” [2]
SABR relies on precise localization of the tumor and careful consideration of nearby critical structures to avoid high doses in the sensitive region
Summary
Non-small-cell lung cancer (NSCLC) in its early stage can be treated definitively with favorable outcomes. The standard for curative therapy has historically been surgery for those medically able to undergo a lobectomy. Given the frequent coincident morbidities such as elderly age, cardiac disease, and poor pulmonary function influenced by tobacco use, a significant proportion of patients are not operative candidates. Developing technologies have introduced lessinvasive methods of addressing early-stage NSCLC with curative intent, including advances in external beam radiotherapy
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