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What Is the Role of Radiotherapy in Early-Stage Lung Cancer?
The number of individuals eligible for lung cancer screening has nearly doubled since the U.S. Preventive Services Task Force recently expanded guidelines to include individuals 50 to 80 years of age who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Moreover, the number of pulmonary nodules discovered incidentally on computed tomography during screening has also markedly increased.
For patients with pulmonary nodules requiring treatment, the role of thoracic surgery is well established, but the role of radiotherapy is unclear. To address this issue, investigators conducted a prospective cohort study of 1150 patients who presented with pulmonary nodules at a lung cancer screening clinic during a 7-year period (2012–2019).
Among 196 patients with incidental nodules requiring treatment, 136 (69%) underwent surgery and 60 (31%) underwent stereotactic body radiotherapy (SBRT). Among 41 patients with screen-detected nodules requiring treatment, 31 (76%) underwent surgery and 10 (24%) underwent SBRT. Among patients who underwent SBRT, 2-year overall survival was 87% and 2-year metastasis-free survival was 94%.
As the number of patients with screen-detected or incidental pulmonary nodules has increased, multidisciplinary evaluation has become a widely recommended measure to ensure their effective care. Yet, although multidisciplinary teams have traditionally included thoracic radiologists, pulmonologists, and thoracic surgeons in this setting, they have not tended to include radiation oncologists. Because SBRT is a valuable treatment option for a growing number of patients with screen-detected or incidental nodules, the expertise that radiation oncologists can provide should be included in their multidisciplinary management.
Milligan MG et al.
Title: Incidence of radiation therapy among patients enrolled in a multidisciplinary pulmonary nodule and lung cancer screening clinic.
Source: JAMA Netw Open 2022 Mar 31; [e-pub]. (Abstract/FREE Full Text)