Stereotactic Body Radiotherapy for Medically Inoperable Early-Stage Non–Small Cell Lung Cancer
Mené au Canada sur 233 patients atteints d'un cancer du poumon non à petites cellules de stade I (âge moyen : 75,4 ans ; durée médiane de suivi : 36,1 mois), cet essai randomisé multicentrique de phase III évalue l'efficacité, du point de vue du taux de contrôle local à 3 ans, d'une radiothérapie corporelle stéréotaxique par rapport à une radiothérapie conventionnelle hypofractionnée
Swaminath et al are to be commended for conducting and reporting LUSTRE, a phase 3 randomized clinical trial (RCT) comparing stereotactic body radiotherapy (SBRT) with hypofractionated conventional radiotherapy (hypo-CRT) for peripheral and central medically inoperable stage I non–small cell lung cancer (NSCLC). Despite completing only 68% of the planned accrual, LUSTRE represents a significant and ambitious effort to define the role of SBRT in this setting.Medically inoperable stage I NSCLC presents significant treatment challenges due to patients’ comorbidities, such as cardiac or respiratory issues, which make surgery impractical. In this context, SBRT has revolutionized the treatment landscape by providing high-dose radiation with precise targeting, resulting in excellent local control (LC) and minimal toxicity. These advantages have positioned SBRT as the pragmatic standard of care, despite the lack of level I evidence, for at least a decade. Treatment considerations vary based on tumor location, with different radiation fractions applied to peripheral vs central tumors. Central tumors, located near vital structures like the main bronchus and large vessels, pose a higher risk of treatment-related morbidity, requiring meticulous planning and specialized techniques.
JAMA Oncology , éditorial, 2023