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Individualized Stereotactic Ablative Radiotherapy for Lung Tumors: The iSABR Phase 2 Nonrandomized Controlled Trial.
Michael F Gensheimer1, Harriet Gee2,3, Hiroki Shirato4
1Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California.
JAMA Oncology
|September 14, 2023
Summary
Individualized stereotactic ablative radiotherapy (iSABR) for lung tumors effectively controls local recurrence with reduced doses. This approach minimizes treatment intensity while maintaining excellent outcomes, suggesting its value for future clinical trials.
Area of Science:
- Oncology
- Radiotherapy
- Medical Physics
Background:
- Stereotactic ablative radiotherapy (SABR) is a lung tumor treatment with potential toxicity risks to central structures.
- Retrospective studies indicate small tumors (≤10 cm³) can be controlled with doses <100 Gy.
Purpose of the Study:
- To evaluate if individualizing lung SABR dose and fractionation based on tumor characteristics improves local tumor control.
- To assess the efficacy and safety of an individualized SABR (iSABR) approach.
Main Methods:
- A phase 2 multicenter, nonrandomized trial (iSABR) enrolled 217 patients with non-small cell lung cancer or lung metastases.
- Patients were grouped by cancer type, and tumors were treated with once-daily SABR, with doses varying by tumor size, location, and volume.
- Follow-up data were analyzed for local recurrence, distant recurrence, survival, and toxicity.
Main Results:
- One-year freedom from local recurrence was high across all groups (94%-97%).
- Five-year local recurrence rates ranged from 83% to 93%.
- Grade 3-5 toxic effects were low (5%), with one grade 5 event.
Conclusions:
- Individualized SABR (iSABR) demonstrates excellent local control for lung tumors.
- This approach may allow for dose minimization, reducing toxicity.
- Individualized dosing strategies warrant further investigation in future clinical trials.
