Severe chronic obstructive pulmonary disease (COPD) may be a contraindication to surgical therapy in patients with early-stage non-small cell lung carcinoma (NSCLC). In carefully selected patients, stereotactic body radiation therapy (SBRT) is a relatively new treatment that expands treatment options.
Utilizing multiple radiation beam angles to target a tumor (typically < 5 centimeters in size) with high-ablative radiation doses, SBRT also minimizes radiation to adjacent normal tissue. While the therapeutic course of traditional radiation treatments is six to seven weeks, SBRT can be completed in just three to five days over one to two weeks. SBRT is generally delivered without concurrent chemotherapy.
Prospective observational (phase II) studies of SBRT in stage I or II NSCLC (T1 or T2) have shown short-term outcomes similar to surgery. Data on long-term outcomes are not yet available.
There is a subset of patients with early-stage NSCLC and comorbid illness in whom surgical risk is higher, though not necessarily prohibitive. For such patients, the standard of care is not yet known. Limited resection surgeries or SBRT could be offered for many.
To help answer these questions, Mayo Clinic is participating in a phase III randomized trial comparing sublobar resection (with or without brachytherapy) with SBRT in higher risk (FEV1 or DLCO < 50 percent predicted) surgical patients with T1 disease.