Inoperable Early-Stage Non-Small-Cell Lung Cancer: Stereotactic Ablative Radiotherapy and Rationale for Systemic Therapy

J Clin Oncol. 2022 Feb 20;40(6):539-545. doi: 10.1200/JCO.21.01611. Epub 2022 Jan 5.

Abstract

Stereotactic ablative radiotherapy (SABR) is the standard treatment for medically inoperable, early-stage non-small-cell lung cancer. SABR results in high rates of in-field tumor control, but among larger and more biologically aggressive tumors, regional and distant failures are problematic. Cytotoxic chemotherapy is rarely used in this patient population and the benefit is unclear. Alternative systemic therapy options with a milder side-effect profile are of considerable interest, and several randomized phase III trials are currently testing immune checkpoint inhibitors in this setting. We review the rationale, data, and ongoing studies evaluating systemic therapy in medically inoperable, early-stage non-small-cell lung cancer treated with SABR.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Carcinoma, Non-Small-Cell Lung / immunology
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Humans
  • Immune Checkpoint Inhibitors / administration & dosage*
  • Immune Checkpoint Inhibitors / adverse effects
  • Immunotherapy* / adverse effects
  • Immunotherapy* / mortality
  • Lung Neoplasms / immunology
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Molecular Targeted Therapy
  • Neoplasm Staging
  • Radiosurgery* / adverse effects
  • Radiosurgery* / mortality
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome

Substances

  • Immune Checkpoint Inhibitors