Dr Lee on the Role of SABR in Non–Small Cell Lung Cancer Management

“In most places [in the body], SABR can be used with regular radiation technology, but in special situations when the isolated tumors are in difficult-to-treat parts [of the body], that's where proton therapy [or] MRI-guided SABR would be beneficial.”

Percy Lee, MD, vice chair of Clinical Research in the Department of Radiation Oncology, medical director of Orange County & Coastal Region Radiation Oncology, and a professor in the Department of Radiation Oncology at City of Hope, discussed the applications of stereotactic ablative body radiotherapy (SABR) for the treatment of patients with non–small cell lung cancer (NSCLC).

The fundamental utility of SABR in radiation is its status as a noninvasive treatment, Lee began. This modality is significant because traditional surgery may not be safely executed in every location, or it may involve a level of complexity that is undesirable for the patient or the clinical team, he explained. Lee confirmed that, for the most part, SABR can be effectively employed across major anatomical regions, including the brain, chest, abdomen, and pelvis. The successful deployment of this technique, however, depends heavily on both the available technology and the specialized expertise of the clinical facility, he noted.

Lee further emphasized that although SABR can often be used effectively with regular radiation technology in most anatomical regions, special situations demand advanced technological approaches. For instance, certain advanced technologies are required to safely treat more complicated regions, particularly those located near highly sensitive tissues, such as the bowel, he continued. When an isolated tumor is situated in a particularly difficult part of the anatomy, specialized tools like proton therapy or MRI-guided SABR become significantly beneficial, he added. As an example of institutional capability, Lee reported that City of Hope uses MRI-guided technology.

This paradigm of managing limited metastatic NSCLC with local therapies like SABR has been formally recognized within the oncology community. The ESTRO-ASTRO Consensus defines the standard requirements for oligometastatic disease that is eligible to undergo such local treatment. This consensus requires that patients have 5 or fewer metastatic lesions in total, confirmed through radiological assessment. Furthermore, a critical stipulation is that all identified lesions must be technically treatable using local therapy modalities, which include SABR, surgery, or ablation.