May 3, 2012
Stereotactic body radiotherapy increases survival in elderly lung cancer patients
AMSTERDAM, 2 May 2012, – Widespread use of advanced radiotherapy techniques in the Netherlands has resulted in improved survival among elderly lung cancer patients, according to major new research conducted by one of the country's leading cancer centers. VU University Medical Center (VUMC) in Amsterdam, which has now treated more than a thousand patients for pulmonary tumors using stereotactic ablative radiotherapy (SABR) on treatment machines supplied by Varian Medical Systems (NYSE: VAR), publishes its findings in the latest issue of the journal Annals of Oncology*.
"The greater use of advanced radiotherapy techniques have led to large improvements in survival for Dutch lung cancer patients over the age of 75, many of whom are too frail to undergo surgery," says Dr. Niels Haasbeek from VUMC's department of radiation oncology, who was the first author of the publication. "Those patients in this age group who are fit enough for surgery should also be informed about the curative option of SABR as an alternative to surgery."
Lung cancer is the most common cause of cancer death worldwide(1) yet improvements in overall survival have been minimal in recent decades: five-year survival for non small-cell lung cancer (NSCLC) was 13% in 1975–1977 and had only increased to 16% by 1999–2005(2). Using expertise gained by several years of advanced radiotherapy treatments for early-stage lung cancer patients, clinicians at VUMC embarked on a nationwide study to examine the impact of SABR on survival rates.
SABR – also sometimes referred to as stereotactic body radiotherapy, or SBRT – refers to a method of treating the tumor with a targeted high-energy radiation beam to damage tumor cell DNA and kill the cancer cell.
"SABR was first used in the Netherlands at VUMC in 2003, so we used the Dutch National Cancer Registry to examine survival data for three defined periods – the three-year period before it was introduced, the three-year period while it was becoming available at other Dutch centers, and the three years when it was available nationwide," adds Professor Suresh Senan, radiation oncologist at VUMC who led the study based on nationwide data. "We noted a marked improvement in survival among the nearly 5,000 lung cancer patients aged over 75 who were treated over these nine years."
During the period covered by the retrospective study, advanced techniques such as SABR led to radiotherapy use for lung cancer patients increasing from 31 percent to nearly 38 percent and a corresponding increase in survival of nearly 10 months from 16.8 months to 26.1 months.
SABR at VUMC
Clinicians at VUMC have treated more than 800 stage 1 lung tumor patients in the last nine years, the majority using SABR. The clinic, which receives referrals from more than 70 Dutch hospitals, treats patients on six Varian linear accelerators, including two TrueBeam™ devices and a Novalis Tx™ machine.
Since 2008, all lung SABR treatments at VUMC have been delivered using Varian's RapidArc® technology, many on the TrueBeam system. According to Professor Ben Slotman, head of radiation oncology, the main benefit of RapidArc for lung patients is the shorter treatment time with less risk of motion.
"This is especially important for SABR, where high doses are delivered over fewer treatment sessions," he says. "The delivery of the highest dose for lung tumors was reduced from 30 minutes to just six minutes. With the introduction of TrueBeam technology, the integration between imaging and treatment delivery has been improved. By using the High Intensity Mode in the very near future, we expect to reduce the treatment time to less than three minutes."
Prior to the latest paper in the journal Annals of Oncology, VUMC has published a series of scientific papers on the progress of SABR in many peer reviewed journals.(3)
Editorial contact: Neil Madle, Varian Medical Systems, +44 7786 526068
About Varian Medical Systems
Varian Medical Systems, Inc., of Palo Alto, California, is the world's leading manufacturer of medical devices and software for treating cancer and other medical conditions with radiotherapy, radiosurgery, and brachytherapy. The company supplies informatics software for managing comprehensive cancer clinics, radiotherapy centers and medical oncology practices. Varian is a premier supplier of tubes and digital detectors for X-ray imaging in medical, scientific, and industrial applications and also supplies high-energy X-ray devices for cargo screening and non-destructive testing applications. Varian Medical Systems employs approximately 6,000 people who are located at manufacturing sites in North America, Europe, and China and approximately 70 sales and support offices around the world. For more information, visit http://www.varian.com or follow us on Twitter.
* Early-stage lung cancer in elderly patients: A population-based study of changes in treatment patterns and survival in the Netherlands doi:10.1093/annonc/mds081
(1) Ferlay J, Shin HR, Bray F et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12): 2893–2917.
(2) Kris MG, Benowitz SI, Adams S et al. Clinical cancer advances 2010: annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 2010; 28(36): 5327–5347.
(3) Lagerwaard F.J. et al., Outcomes of stereotactic ablative radiotherapy in patients with potentially operable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):348-53. Lagerwaard FJ et al. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008;70(3):685–692. Verstegen NE et al. Outcomes of stereotactic ablative radiotherapy following a clinical diagnosis of stage I NSCLC: comparison with a contemporaneous cohort with pathologically proven disease. Radiother Oncol. 2011 Nov;101(2):250-4. Bongers EM et al. Incidence and risk factors for chest wall toxicity after risk-adapted stereotactic radiotherapy for early-stage lung cancer. J Thorac Oncol. 2011 Dec;6(12):2052-7.