Stereotactic ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol

Biniam Kidane^{1

2

3}, Ian J Gerard⁴, Jonathan Spicer^{5

6}, Julian O Kim^{3

7}, Pierre O Fiset⁸, Paul Wawryko⁹, Matthew J Cecchini¹⁰, Richard Inculet¹¹, Bassam Abdulkarim⁴, Dalilah Fortin¹¹, Mehdi Qiabi¹¹, Gefei Qing¹², Stephanie Enns¹, Bashir Bashir^{3

7}, James Tankel⁵, Elliot Wakeam¹³, Andrew Warner¹⁴, Neil Kopek⁴, Brian P Yaremko¹⁴, George B Rodrigues¹⁴, Joanna M Laba¹⁴, Melody Qu¹⁴, Richard A Malthaner¹¹, David A Palma¹⁴

Affiliations

¹ Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
² Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada.
⁵ Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
⁶ Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
⁷ Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁸ Department of Pathology, McGill University, Montreal, Quebec, Canada.
⁹ Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
¹¹ Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada.
¹² Department of Physiology and Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.
¹³ Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Division of Radiation Oncology, Western University, London, Ontario, Canada.

PMID: 37221679
DOI: 10.1002/cncr.34880

Free article

Stereotactic ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol

Biniam Kidane et al. Cancer. 2023.

Free article

. 2023 Sep 15;129(18):2798-2807.

doi: 10.1002/cncr.34880. Epub 2023 May 23.

Authors

Affiliations

¹ Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
² Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada.
⁵ Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
⁶ Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
⁷ Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁸ Department of Pathology, McGill University, Montreal, Quebec, Canada.
⁹ Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
¹¹ Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada.
¹² Department of Physiology and Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.
¹³ Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Division of Radiation Oncology, Western University, London, Ontario, Canada.

PMID: 37221679
DOI: 10.1002/cncr.34880

Abstract

Background: During coronavirus disease 2019 (COVID-19)-related operating room closures, some multidisciplinary thoracic oncology teams adopted a paradigm of stereotactic ablative radiotherapy (SABR) as a bridge to surgery, an approach called SABR-BRIDGE. This study presents the preliminary surgical and pathological results.

Methods: Eligible participants from four institutions (three in Canada and one in the United States) had early-stage presumed or biopsy-proven lung malignancy that would normally be surgically resected. SABR was delivered using standard institutional guidelines, with surgery >3 months following SABR with standardized pathologic assessment. Pathological complete response (pCR) was defined as absence of viable cancer. Major pathologic response (MPR) was defined as ≤10% viable tissue.

Results: Seventy-two patients underwent SABR. Most common SABR regimens were 34 Gy/1 (29%, n = 21), 48 Gy/3-4 (26%, n = 19), and 50/55 Gy/5 (22%, n = 16). SABR was well-tolerated, with one grade 5 toxicity (death 10 days after SABR with COVID-19) and five grade 2-3 toxicities. Following SABR, 26 patients underwent resection thus far (13 pending surgery). Median time-to-surgery was 4.5 months post-SABR (range, 2-17.5 months). Surgery was reported as being more difficult because of SABR in 38% (n = 10) of cases. Thirteen patients (50%) had pCR and 19 (73%) had MPR. Rates of pCR trended higher in patients operated on at earlier time points (75% if within 3 months, 50% if 3-6 months, and 33% if ≥6 months; p = .069). In the exploratory best-case scenario analysis, pCR rate does not exceed 82%.

Conclusions: The SABR-BRIDGE approach allowed for delivery of treatment during a period of operating room closure and was well-tolerated. Even in the best-case scenario, pCR rate does not exceed 82%.

Keywords: early-stage lung cancer; oligometastases; pathologic outcomes; radiotherapy; stereotactic; surgery.

PubMed Disclaimer

References

REFERENCES

1. McDonald F, Waele MD, Hendriks LEL, Faivre-Finn C, Dingemans AMC, Van Schil PE. Management of stage I and II nonsmall cell lung cancer. Eur Respir J. 2017;49(1):1600764. doi:10.1183/13993003.00764-2016
1. Chang JY, Senan S, Paul MA, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630-637. doi:10.1016/s1470-2045(15)70168-3
1. VA Office of Research and Development. CSP #2005 - Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy Trial (VALOR). ClinicalTrials.gov; 2022.
1. Guckenberger M, Belka C, Bezjak A, et al. Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: an ESTRO-ASTRO consensus statement. Radiother Oncol. 2020;146:223-229. doi:10.1016/j.radonc.2020.04.001
1. Thoracic Surgery Outcomes Research Network, Inc, Antonoff M, Backhus L, et al. COVID-19 guidance for triage of operations for thoracic malignancies: a consensus statement from Thoracic Surgery Outcomes Research Network. Ann Thorac Surg. 2020;110(2):692-696. doi:10.1016/j.athoracsur.2020.03.005

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Stereotactic ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol

Affiliations

Stereotactic ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical