Abstract
Simple SummaryAdoption of single-fraction stereotactic body radiation therapy for lung tumors has been limited among different institutions even during the coronavirus disease 2019 (COVID-19) pandemic. Potential reasons may include a lack of familiarity and concerns regarding potential toxicities. To address this knowledge gap, we performed a systematic review of prospective literature on single-fraction SBRT. Our PubMed search of prospective trials resulted in nine studies that showed favorable local control and survival outcomes among peripheral tumors. Many toxicities were grade 1–2, with 0–17% of patients experiencing grade ≥3 toxicity. Encouraging outcomes suggest that the utility of single-fraction stereotactic body radiation therapy may extend beyond the current COVID-19 pandemic.Adoption of single-fraction lung stereotactic body radiation therapy (SBRT) for patients with medically inoperable early stage non-small-cell lung cancer (NSCLC) or oligometastatic lung disease, even during the coronavirus disease 2019 (COVID-19) pandemic, was limited despite encouraging phase II trial results. Barriers to using single-fraction SBRT may include lack of familiarity with the regimen and lack of clarity about the expected toxicity. To address these concerns, we performed a systematic review of prospective literature on single-fraction SBRT for definitive treatment of early stage and oligometastatic lung cancer. A PubMed search of prospective studies in English on single-fraction lung SBRT was conducted. A systematic review was performed of the studies that reported clinical outcomes of single-fraction SBRT in the treatment of early stage non-small-cell lung cancer and lung oligometastases. The current prospective literature including nine trials supports the use of single-fraction SBRT in the definitive treatment of early stage peripheral NSCLC and lung oligometastases. Most studies cite local control rates of >90%, mild toxicity profiles, and favorable survival outcomes. Most toxicities reported were grade 1–2, with grade ≥3 toxicity in 0–17% of patients. Prospective trial results suggest potential consideration of utilizing single-fraction SBRT beyond the COVID-19 pandemic.
Highlights
During the coronavirus disease 2019 (COVID-19) pandemic, treatment recommendations for cancer have emphasized delivering high-quality care while minimizing in-person interactions between patients and healthcare providers [1]
A comprehensive PubMed search of published journal articles written in English related to single-fraction lung SBRT was performed using keywords “single fraction”, “stereotactic body radiation therapy”, “SBRT”, “SABR”, “lung cancer”, “non-small-cell lung cancer (NSCLC)”, and
This study suggested that 25 Gy in a single fraction was well-tolerated in previously untreated patients; single-fraction SBRT was too toxic in patients with prior thoracic radiation and/or chemotherapy, especially those with large or central tumors [25]
Summary
During the coronavirus disease 2019 (COVID-19) pandemic, treatment recommendations for cancer have emphasized delivering high-quality care while minimizing in-person interactions between patients and healthcare providers [1]. For medically inoperable patients with early stage non-small cell lung cancer (NSCLC) or lung oligometastases, a range of treatment guidelines has supported stereotactic body radiation therapy (SBRT) [2,3,4,5,6]. Prospective trials [10,11] and retrospective studies [12,13,14] showed similar outcomes for NSCLC patients treated with single- and multi-fraction SBRT. Network (NCCN) guidelines support single-fraction lung SBRT for peripheral NSCLC [15]. A randomized trial in pulmonary oligometastases suggested similar outcomes at 1 year post single- or multi-fraction SBRT [16]
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