SBRT: Why Is a Powerful Treatment for Lung Cancer Hardly Known?

Stereotactic body radiation therapy for early-stage cancer

Up until twenty years ago, surgery was the only option that could potentially cure early-stage non-small-cell lung cancer (NSCLC). However, if your body couldn’t handle the stress of surgery, your lung cancer could be treated, but not cured.

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Now there’s a safe alternative to surgery, yet many people don’t know about it.

When researchers found a way to deliver a targeted dose of radiation to lung cancer patients who weren’t good candidates for surgery, that was a huge leap forward in treatment, says Gregory Videtic, MD, Section Head for Thoracic Malignancies in Cleveland Clinic’s Department of Radiation Oncology.

This treatment, known as stereotactic body radiation therapy (SBRT), delivers a precisely targeted radiation dose that attacks the cancer while helping to spare the surrounding healthy tissue.

Why you may not have heard of SBRT

It’s an effective alternative to surgery, but if you’ve never heard of SBRT (sometimes also called “radiosurgery”), you’re not alone. Dr. Videtic, who has studied the therapy for years, explains why you should know about it, and he offers four reasons why you may not.

  1. It works, but it’s not the industry standard
    Surgery was the gold standard for treating curable lung cancer. Dr. Videtic says SBRT showed promising results early on for patients who could not have surgery who were similar to those who could. However, it was 10 years before SBRT started to receive widespread recognition in the medical field.

    This is because a new treatment is judged against surgery results. SBRT needed to go beyond being a safe treatment; when compared to surgery, it had to cure patients at the same rate over time. Gathering this data takes years and involves closely following patients.

    Even now, another 10 years later, it’s mainly large health care systems that offer the treatment, Dr. Videtic says, because this is where lung cancer surgeons and radiation doctors work closely together. Also, many smaller hospitals and practices have been appropriately slower to adopt it because of the technical requirements involved to implement it.

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  2. It reduces cancer deaths but isn’t an option for everyone yet
    Each year, doctors diagnose approximately 200,000 new cases of lung cancer — and more than 150,000 people die from it.

    “But it’s caught in the early stages only 10 to 15 percent of the time,” Dr. Videtic says.

    SBRT is generally offered only to some of those diagnosed in early stages who aren’t good candidates for surgery. Because these patients had no other options before SBRT, it has been a gift for them. For patients who can handle an operation, we need more time to show both the effectiveness and safety of this treatment, Dr. Videtic says.

  3. Doctors may be familiar with this treatment for brain tumors but not lung cancer
    Doctors have used an approach like SBRT to treat certain kinds of tumors in the brain for about 60 years. This means that even primary care physicians who have looked after patients with cancer may be familiar with “radiosurgery” in the brain as a treatment approach. However, Dr. Videtic says outside of doctors who care specifically for lung cancer patients, few may be familiar with lung SBRT.

    “Lung cancer is still thought of as a surgical disease so they get to see the patients first,” he says. “Smaller oncology practices may opt to stick with what they know firsthand that they think will work, so the referrals go to the surgeons.”

    This technology is also being evaluated for its effectiveness in treating tumors in other parts of the body, including the prostate, liver, head and neck, and spine.

  4. Research shows benefits, but still needs to reach a wider audience
    Dr. Videtic has long been involved in research to expand or improve SBRT. Most recently, he worked on a study for a specific group of patients who could not have surgery for their early stage lung cancer. Researchers found that a single high dose of radiation delivered with SBRT was as effective as an SBRT dose delivered in three sessions. It also had the same very low rate of significant side effects.

    This means that you could have one treatment instead of many — with similar results.

    Dr. Videtic sees this as a good option for certain patients who have early stage lung cancer of a given size located in a particular part of the lung. This single treatment option may be especially important  if you live a long way from your hospital or oncologist. SBRT is performed on an outpatient basis, which means that after the consultation and the required visit to plan the lung SBRT, the actual treatament will involve one trip, he says.

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    At this time, SBRT is right for a small subset of patients with lung cancer. But with more experience with SBRT, and because of the willingness of patients to explore this option, this treatment may become appropriate for a larger group, Dr. Videtic says.

Explore all of your options

Offering SBRT to patients when it can help is an easy decision, Dr. Videtic says. But he notes that not every patient who could benefit from the therapy will hear about it.

He’s working to change that. He also encourages you to talk to their oncologist about SBRT if surgery isn’t an option for early stage lung cancer.

It may not work for you, but it’s important to know it could be an option. Be sure to talk with a doctor who can help you make the most informed choice possible.

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