Table 1 Challenges and solutions for difficult SABR scenarios
From: A critical review of recent developments in radiotherapy for non-small cell lung cancer
Clinical scenario | Challenges | Potential solutions being explored | |
|---|---|---|---|
Pre Treatment | Incorporating patient preferences for treatment | Choice of SABR in operable NSCLC | • Shared decision-making [19, 20] • Comparative effectiveness research (including patient-reported outcomes, QOL and cost-effectiveness analyses) with “big data” strategies to facilitate data mining • RCTs underway (NCT02629458, NCT01753414, NCT02468024, VALOR study) |
Obtaining a diagnosis | Risks of treating benign disease Risks of biopsy in frail patients | •Use validated models for cancer risk determination in a given population [9] • Explore blood biomarkers [123] | |
Treatment | Central tumors Multiple primary lung cancers | Proximity to OARs Uncertainty in OAR location Uncertainly in OAR dose constraints | • “Big data” strategies to establish more reliable OAR dose constraints • MRI-guided adaptive RT [44] • Protons [41] |
Oligometastases | Higher pneumonitis risk Identify molecular and clinical characteristics of patients likely to benefit from ablative local therapies Optimize sequencing of RT and new systemic treatments | • Phase I-II trials, as well as randomized trials | |
Follow-up | Detection of recurrences | Distinguishing post-RT fibrosis vs recurrent disease | • Radiomic approaches [24] |
Survivorship issues | Loco-regional recurrences and second lung tumors Smoking cessation | • Survivorship clinics [124] • Patient-reported outcomes, including financial impact of treatments | |