Hanbo Chen

Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer : Results from the ROSEL multicenter randomized trial

We report quality of life and indirect costs from patient reported outcomes from the ROSEL randomized control trial comparing stereotactic ablative radiotherapy (SABR, also known as stereotactic body radiotherapy or SBRT) versus surgical resection for medically operable stage IA non-small cell lung cancer. ROSEL closed prematurely after accruing and randomizing 22 patients. This exploratory analysis found the global health related quality of life and indirect costs to be significantly favorable and cheaper, with SABR.

Stereotactic Ablative Radiotherapy (SABR) for Large Renal Tumors: A Retrospective Case Series Evaluating Clinical Outcomes, Toxicity, and Technical Considerations.

Objectives: Metastatic renal cell carcinoma represents a clinical scenario where aggressive treatment to the primary tumor (ie, cytoreductive nephrectomy) is associated with a survival benefit. We hypothesized that stereotactic ablative radiotherapy (SABR) could be a safe alternative local modality for inoperable metastatic renal cell carcinoma patients. Our study objectives were to report on technical considerations, toxicity, and clinical outcomes of our institutional experience with renal SABR. Materials and Methods: Patients who underwent renal SABR at our institution between January 2008 and June 2015 were reviewed. Toxicity was quantified using the Common Terminology Criteria for Adverse Events version 4.0. Radiographic response was evaluated using the Response Evaluation Criteria in Solid Tumors classification. Median overall survival and follow-up were calculated using the Kaplan-Meier and reverse Kaplan-Meier methods, respectively. Results: We identified 11 patients that met study criteria. SABR was directed to the tumor or whole kidney in 5 fractions to a dose of 25 to 40 Gy. Median tumor diameter and planning target volume were 9.5 cm (range, 7.5 to 24.4) and 819.3 cm3 (range, 313.4 to 5704.3), respectively. Median follow-up was 3.9 years (95% confidence interval, 0.6-4.9). Five cases of grade 1 toxicity were reported. In the patient with the largest target, grade 2 diarrhea and probable grade 3 nausea were observed. In patients with available follow-up imaging (7/11), stable disease (n=5), partial response (n=1), and progressive disease (n=1) were observed. Median overall survival was 20.4 months (95% confidence interval, 2.30-N/A). Conclusions: In this small cohort, renal SABR was delivered with minimal toxicity. A prospective study is underway at our institution to determine maximum tolerable and optimal dosing (NCT02264548).

Surgery versus SABR for early stage non-small cell lung cancer: the moving target of equipoise

The notion that lobectomy is the standard treatment approach for operable early stage non-small cell cancer (ES-NSCLC) was recently challenged by the results from a combined analysis of two prematurely closed randomized controlled trials (STARS and ROSEL trials; NCT00840749 and NCT00687986) (1). In this study, Chang et al. pooled data from 58 patients with operable T1–2a (<4 cm) N0M0 NSCLC treated with lobectomy versus stereotactic ablative radiotherapy (SABR) and reported a similar 3-year recurrence-free survival between the two modalities and a 3-year overall survival (OS) in favour of SABR. Despite the numerous limitations inherent to post-hoc analysis of studies with a small sample size, these results have cast doubt over the superiority of surgery and supported SABR as a valid alternate option in operable patients with ES-NSCLC.

Stereotactic ablative radiotherapy and surgery: two gold standards for early-stage non-small cell lung cancer?

There is growing clinical equipoise between surgery and stereotactic ablative radiotherapy (SABR) in the management of early-stage non-small cell lung cancer (ES-NSCLC). Increasing evidence suggest similar outcomes between these modalities. Through the guidance of a multidisciplinary team, a shared decision making approach in this setting in favoured.