Hochpräzisionsstrahlentherapie bei Patient*innen mit NSCLC

Die Strahlentherapie stellt in jedem Stadium des nichtkleinzelligen Lungenkarzinoms (NSCLC) eine potenzielle Therapie dar. Bei internistischer oder chirurgischer Inoperabilität besteht für Patient*innen mit lokalisierter Erkrankung die einzige kurative Therapiestrategie in der (Präzisions-)Radio(-system-)therapie. Beispiele ihrer Anwendung sollen nachfolgend erläutert werden.

Schlüsselwörter

NSCLC - SBRT - Immuntherapie - Metastasen

• Literatur

• 1 Guckenberger M, Andratschke N, Alheit H. et al. Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol 2014; 190 (01) 26-33
• 2 Timmerman R, Paulus R, Galvon J. et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 2010; 303 (11) 1070-1076
• 3 Ball D, Tao Mai G, Vinod S. et al. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial. Lancet Oncol 2019; 20 (04) 494-503
• 4 Haasbeek CJ, Lagerwaard FJ, Slotman J. et al. Outcomes of stereotactic ablative radiotherapy for centrally located early-stage lung cancer. J Thorac Oncol 2011; 6 (12) 2036-2043
• 5 Bezjak A, Paulus R, Gaspar LE. et al. Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/RTOG 0813 Trial. J Clin Oncol 2019; 37 (15) 1316-1325
• 6 Lindberg K, Grozman V, Karlsson K. et al. The HILUS-Trial-a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy. J Thorac Oncol 2021; 16 (07) 1200-1210
• 7 Lindberg S, Grozman V, Karlsson K. et al. Expanded HILUS Trial: A Pooled Analysis of Risk Factors for Toxicity From Stereotactic Body Radiation Therapy of Central and Ultracentral Lung Tumors. Int J Radiat Oncol Biol Phys 2023; 117 (05) 1222-1231
• 8 Bucknell NW, Kron T, Herschtal A. et al. Comparison of Changes in Pulmonary Function After Stereotactic Body Radiation Therapy Versus Conventional 3-Dimensional Conformal Radiation Therapy for Stage I and IIA Non-Small Cell Lung Cancer: An Analysis of the TROG 09.02 (CHISEL) Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117 (02) 378-386
• 9 Palma DA, Bahig H, Hope A. et al. Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial. JAMA Oncol 2024; 10 (05) 575-582
• 10 Chang JY, Lin SH, Dong W. et al. Stereotactic ablative radiotherapy with or without immunotherapy for early-stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer: an open-label, randomised, phase 2 trial. Lancet 2023; 402: 871-881
• 11 Altorki NK, McGraw TE, Borczuk AC. et al. Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial. Lancet Oncol 2021; 22 (06) 824-835
• 12 Spigel DR, Faivre-Finn C, Gray JE. et al. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. J Clin Oncol 2022; 40 (12) 1301-1311
• 13 Lu S, Kato T, Dong X. et al. Osimertinib after Chemoradiotherapy in Stage III EGFR-Mutated NSCLC. N Engl J Med 2024; 391 (07) 585-597
• 14 Chun SG, Hu C, Choy H. et al. Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial. J Clin Oncol 2017; 35 (01) 56-62
• 15 Chun SG, Hu C, Komaki RU. et al. Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2024; 10 (08) 1111-1115
• 16 Nestle U, Schimek-Jasch T, Kremp S. et al. Imaging-based target volume reduction in chemoradiotherapy for locally advanced non-small-cell lung cancer (PET-Plan): a multicentre, open-label, randomised, controlled trial. Lancet Oncol 2020; 21 (04) 581-592
• 17 Vera P, Thureau S, Le Tinier F. et al. Adaptive radiotherapy (up to 74 Gy) or standard radiotherapy (66 Gy) for patients with stage III non-small-cell lung cancer, according to [(18)F]FDG-PET tumour residual uptake at 42 Gy (RTEP7-IFCT-1402): a multicentre, randomised, controlled phase 2 trial. Lancet Oncol 2024; 25 (09) 1176-1187
• 18 Zhao ZR, Liu S, Zhou T. et al. Stereotactic body radiotherapy with sequential tislelizumab and chemotherapy as neoadjuvant therapy in patients with resectable non-small-cell lung cancer in China (SACTION01): a single-arm, single-centre, phase 2 trial. Lancet Respir Med. 2024
• 19 Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep 2012; 14 (01) 48-54
• 20 PatchellRATibbs PA, Walsh JW. et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322 (08) 494-500
• 21 Patchell RA, Tibbs PA, Regine WF. et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 1998; 280 (17) 1485-1489
• 22 Mahajan A, Ahmed S, McAleer MF. et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 2017; 18 (08) 1040-1048
• 23 Brown PD, Ballman KV, Cerhan JH. et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 2017; 18 (08) 1049-1060
• 24 Vogelbaum MA, Brown PD. et al. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. J Clin Oncol 2022; 40 (05) 492-516
• 25 Yamamoto M, Serizawa T, Shuto T. et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 2014; 15 (04) 387-395
• 26 Shuto T, Akabane A, Yamamoto M. et al. Multiinstitutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases from non-small cell lung cancer (JLGK0901 study-NSCLC). J Neurosurg 2018; 129 (Suppl. 01) 86-94
• 27 El Shafie RA, Bernhardt D, Welzel T. et al. Stereotactic Radiosurgery for 1–10 Brain Metastases to avoid Whole-Brain Radiotherapy – Results of the CYBER-SPACE Randomized Phase 2 Trial. Neuro Oncol 2024;