Guerrero, E., Ahmed, M. (2016) The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer. LUNG CANCER, 92. pp. 22-28. ISSN 0169-5002

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Abstract

Our understanding of metastatic disease has evolved significantly in the last 20 years. Considered strictly a systemic issue, local treatment would only have significant impact in terms of palliation. However, Hellman and Weichselbaum stated that there might be an intermediate state, in which controlling limited metastatic sites could improve oncologic outcomes. This is called an oligometastatic state, a point between locally confined cancer and widespread disease [1,2]. As treatment with chemotherapy alone for non small cell lung cancer (NSCLC) yields median survivals of 8-11 months [3] and minimal chances of long term survival, new strategies are needed to offer better odds for metastatic patients. Outcomes tend to be better in patients with low volume metastatic disease. [4,5], leading us to question whether the oligometastatic group of patients will gain from a more radical treatment paradigm. In this setting, ablative treatments like surgery or SBRT may provide longer survival and better local control times. There is a rationale for the use of ablative local treatments, as most failures after chemotherapy occur at sites initially affected by disease, and these sites could be a source of further dissemination. Also, chemotherapy resistance can adversely impact resolution of metastatic disease [6]. In rare cases, the abscopal effect (an immune effect arising after radiotherapy in non irradiated metastatic sites) has been described [7,8]. In this review article, we address the impact of SBRT in oligometastatic NSCLC, the most relevant prognostic factors, indications and a site specific review. This review will focus on SBRT for extracranial disease as the role for intracranial SBRT is established. Crown Copyright (C) 2015 Published by Elsevier Ireland Ltd. All rights reserved.

Item Type:	Review Article
All Authors:	Guerrero, E., Ahmed, M.
Additional Information:	ISI Document Delivery No.: DC8GQ Times Cited: 0 Cited Reference Count: 78 Guerrero, Eduardo Ahmed, Merina NHS Executive; NHS This work was undertaken in The Royal Marsden NHS Foundation Trust who received a proportion of its funding from the NHS Executive; the views expressed in this publication are those of the authors and not necessarily those of the NHS Executive. We acknowledge NHS funding to the NIHR Biomedical Research Centre. 0 2 ELSEVIER IRELAND LTD CLARE LUNG CANCER
Uncontrolled Keywords:	Oligometastatic Lung cancer Stereotactic BODY RADIATION-THERAPY PHASE-I/II TRIAL UNRESECTABLE LIVER METASTASES ADRENAL-GLAND METASTASES PROGNOSTIC-FACTORS EXTRACRANIAL OLIGOMETASTASES SURGICAL-TREATMENT PANCREATIC-CANCER SPINAL METASTASES RADICAL TREATMENT
Research teams:	Clinical Units > Radiotherapy
Depositing User:	Barry Jenkins
Date Deposited:	18 Mar 2016 11:39
Last Modified:	18 Mar 2016 11:39
URI:	http://publications.icr.ac.uk/id/eprint/14820

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