A ray of hope was presented at this year's ASTRO annual meeting for patients with early-stage lung cancer who are too sick to undergo surgery. Emerging evidence indicates that a specialized form of radiation therapy called stereotactic body radiation therapy (SBRT) can kill tumors with almost no recurrence of cancer at the site of treatment after three years.

The prospective trial involved 59 inoperable non-small cell lung cancer patients undergoing SBRT, who, due to co-morbidities like stroke or heart disease, were too medically frail for surgical resection of their tumors. Analyzed third year data showed that only one patient experienced a recurrence of cancer at the treated site and, generally, SBRT presented the best possible treatment for these patients when compared to conventional radiation therapy.

"The study confirms that SBRT should now be considered a standard treatment," says Robert D. Timmerman, M.D., a radiation oncologist at the University of Texas Southwestern Medical Center in Dallas and lead author of the Radiation Therapy Oncology Group study.

"We were pleasantly surprised that with the mature data it was actually a 98 percent control rate at the primary site, which meant that out of the 59 patients enrolled, only one patient experienced a recurrence of their tumor by three years," Dr. Timmerman said. "This is the highest local control rate that we've seen in such RTOG trials."

Despite having other life-threatening illnesses, 56 percent of the patients were still alive at the conclusion of the three-year study. In fact, lung cancer was the cause of death for fewer than 20 percent of those who died, and those cases typically involved further metastases that had not been caught during initial screening.

The results of this study may lead to further trials in which patients with moderately operable non-small cell lung cancer are treated with SBRT to gauge how the treatment measures up to surgery.

"We're not saying that we think [SBRT] will unseat surgery necessarily, but there might be patients that would prefer an option, or subsets of patients who would be better treated with this therapy," said Dr. Timmerman.

Conventional radiation therapy for these patients currently involves treatment sessions delivering radiation in low doses spanning a period of six to eight weeks for a total radiation dose of about 60 Gy. Timmerman said that only 30 to 50 percent of tumors treated with conventional therapy are eradicated and do not recur at the original site of treatment, which is discouraging.

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