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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 |
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| Authors: | Biniam Kidane MD MSc Ian J Gerard MD PhD Jonathan Spicer MD PhD Julian O Kim MD MSc BEng Pierre O Fiset MD PhD Paul Wawryko MD Matthew J Cecchini MD PhD Richard Inculet MD Bassam Abdulkarim MD PhD Dalilah Fortin MD Mehdi Qiabi MD MSc Gefei Qing MD Stephanie Enns BSc Bashir Bashir MBBS James Tankel MD Elliot Wakeam MD Andrew Warner MSc Neil Kopek MD Brian P Yaremko MD MSc PEng George B Rodrigues MD PhD Joanna M Laba MD Melody Qu MD MPH Richard A Malthaner MD MSc David A Palma MD PhD |
| Institution: | 1. Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada;2. Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada;3. Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
Research Institute of the McGill University Health Center, Montreal, Quebec, Canada;4. Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada;5. Department of Pathology, McGill University, Montreal, Quebec, Canada;6. Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada;7. Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada;8. Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada;9. Department of Physiology and Pathology, University of Manitoba, Winnipeg, Manitoba, Canada;10. Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada;11. Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA;12. Division of Radiation Oncology, Western University, London, Ontario, Canada |
| Abstract: | BackgroundDuring 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.MethodsEligible 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.ResultsSeventy-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%.ConclusionsThe 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 |