Stereotactic Radiosurgery for Lung Cancer

A Bloodless, Non-invasive, Outpatient Treatment for Lung Tumors

What is Lung Stereotactic Ablative Radiosurgery?

 

Lung Stereotactic Ablative Radiosurgery (SABR) is a non-invasive, highly targeted form of radiation treatment that is recommended in international cancer guidelines as an alternative to surgery in early stage lung cancers for selected patient groups. SABR has been proven in studies to confer excellent survival rates comparable to surgery and is an increasingly important option in early stage lung cancer treatment. 

NCCN Guidelines Lung Cancer

* The NCCN guidelines on NSCLC is written by 30 leading cancer centres in the U.S and is regarded as the gold standard internationally

Lung SABR is also commonly used in stage 4 cancers to target tumors that have spread to the lung, and to prevent or relief symptoms. Often, it is combined with immunotherapy to achieve a synergistic effect. Unlike surgery or other invasive procedures, SABR does not cause disruption to the continued use of chemotherapy or targeted therapy in these patients.

SABR works by using technologically advanced machines to deliver extremely focused beams carrying high doses of radiation directly to the tumour to destroy it.  With SABR, an entire treatment course can be completed in three to five outpatient sessions over two weeks, with no surgical or anaesthetic risk.

Radiosurgery

Modern Linear Accelerator with 6 degrees of freedom robotic couch

Lung SABR

Lung SABR destroys lung cancer with painless and precise radiation beams

What are the risks of surgery?

Surgery for lung cancer is a major operation and can have serious side effects, which is why it isn’t a good idea for everyone.

In general, some of the potential risks and complications of lung cancer surgery may include:

  • Reactions to anaesthesia

  • Excessive bleeding

  • Damage to a lung, blood vessel, nerve or the heart

  • Blood clots in the lung or legs

  • Rarely, some people may not survive the surgery

Recovering from lung cancer surgery typically takes weeks to months and your activity might be limited for at least a month or two.

Risks of surgery

Finally, in a proportion of patients, surgery may be incomplete and remnants of the tumour are left behind. In such situations, these patient will still require further radiation, resulting in them having to undergo 2 treatments instead of one.

 
 

Understanding the difference between Surgery and Radiosurgery

Before

After

Before & After of Lung SABR

Right-sided lung tumor treated with SABR with complete disappearance of tumor 6 months later

Lung SABR Treatment

Surgery involves physically cutting through tissue and bone to reach the tumor so as to remove it from the body.

Radiosurgery does not involve any cutting at all. The name was given because after destroying the tumor with high doses of focused radiation, the body automatically removes the dead cells, and the cure rate is as if surgery was done 

It is completely painless, bloodless and is done as an outpatient procedure.

Patient does not need to undergo open surgery and does not suffer from operation risks

Using advanced technology, radiosurgery precisely targets tumors painlessly, without the need for open surgery

Is it true that if I have radiotherapy first, surgery will be impossible later?

Moreover, with modern radiotherapy equipment & techniques, radiation oncologists are now able to precisely target the tumour while limiting damage to the surrounding tissues, thus minimizing the risk of complications from subsequent surgery.

It is therefore important to see a sub-specialized radiation oncologist and lung cancer surgeon, who are both confident of managing these situations.

Lung Cancer Treatment Surgery
Lung SABR Treatment

It is not true that having radiation first will make surgery impossible in the future. In fact, in certain lung cancer situations, it is standard protocol to have radiation and/or chemotherapy before surgery, in order to shrink the tumour so it can be completely resected.

 

Lung SABR vs other Radiation Therapies

Am I eligible for Lung SABR treatment?


Stereotactic Ablative Radiosurgery (SABR) is endorsed in international cancer guidelines as an alternative option to surgery in selected patients groups, such as those with early stage (stage 1 & stage 2) lung cancers, or at high operative risk.

Patients wishing to find out more should consult a radiosurgeon (not thoracic surgeon) who will assess each case, taking into account patient, tumor and technical factors, to determine if SABR is appropriate. It is important to see the correct specialist with the pre-requisite training and expertise, so that the right assessment can be made, and treatment performed safely. Book your appointment here. For further clarifications, do contact us at +65 8101 3838.




What is the difference between Radiotherapy and Radiosurgery?


Radiosurgery packs all the dose usually given over 5-6 weeks, and gives it over 1-5 days. The Radiosurgeon is a Radiation Oncologist who is trained in both radiotherapy, oncology, and the complex technologies used to deliver Radiosurgery. Since radiation is the ‘knife’ which ‘cuts’ the tumor, it is critical that the Radiosurgeon is well trained with radiation medicine.




What is the difference between Proton Beam Therapy and Radiosurgery?


Radiosurgery and Proton Beam Therapy are both precision radiation therapies. Radiosurgery avoids treating normal tissue by sophisticated beam shaping and modulation, while Proton Beam avoids treating normal tissue by reducing dose deposition during the exit of the beam. They can be used in combination, depending on the location of the target and the diagnosis of the patient.





 

What are the other treatment options for lung cancer?

Chemotherapy


Chemotherapy uses special medications to kill cancer cells. It can be given through oral tablets or with drugs injected into the veins. A combination of drugs is usually given in a series of treatments over a period of a few months, with breaks in between so that you can recover. Chemotherapy for lung cancer can be given before surgery (to shrink the tumour), or after surgery (where the risk of recurrence is high). It can also be combined with radiotherapy. In cases where the cancer has spread beyond the lung to other parts, chemotherapy may be the primary treatment.




Radiosurgery


Radiosurgery is a non-invasive treatment using precise and intense beams of radiation to target the cancer. It borrows from the term “surgery” as this treatment is considered a form of “bloodless” surgery, where the tumour is destroyed without the need for an operation and its accompanying risks, in just a few outpatient sessions. As radiosurgery involves intense beams of highly focused radiation, advanced radiotherapy machines and sub-specialized expertise are required, and patients must be carefully selected. Radiosurgery is an example of how recent technological advances have enabled new treatment options in the treatment of lung cancer. Radiosurgery is now recommended in American and European guidelines as an alternative to surgery in patients with high operative risk, and as an option to be discussed in patients with standard operative risk.




Targeted Therapy


Chemotherapy affects both cancer and normal cells and can cause unwanted side effects. New lung cancer drugs called targeted drug therapies help reduce damage to healthy cells by attacking specific abnormalities on the tumour cells that will disrupt their growth and function. Not all patients are suitable for targeted drug therapy. Before such treatment can be given, a special test called molecular testing will be performed to identify abnormalities on the tumour cells. If abnormalities are identified, a suitable targeted drug will then be selected to treat the cancer. At this moment, targeted drug therapy is used mainly in advanced stage cancers that have spread beyond the lung. Studies are ongoing to see if these drugs can be used for earlier stage cancers.




Immunotherapy


Immunotherapy is one of the newest treatments for lung cancer. Unlike other treatment, it does not attack cancer cells directly but stimulates a person’s immune system to recognise and destroy cells on their own. Such treatments therefore cause fewer side effects and may be more effective.




Surgery


Surgery may be an option if your cancer is small and is confined to the lungs. Advanced surgical techniques such as laparoscopic (minimally invasive) surgery and video-assisted thoracoscopic surgery (VATS) have been introduced in recent years. These techniques cause less pain and fewer complications and may be recommended by your surgeon. However, not all patients are suitable for surgery. Many patients with lung cancer are elderly or have pre-existing medical conditions (such as heart disease or diabetes) which place them at higher risk of complications during and after surgery. In such cases, other treatment options such as radiosurgery or chemotherapy/immunotherapy would be safer and more suitable.




Targeted Radiotherapy


In patients unsuitable for surgery or radiosurgery (such as in larger tumours or more advanced cancers), targeted radiotherapy combined with chemotherapy is usually the primary treatment. It is also sometimes used before or after surgery. Such treatments use radiation beams of lesser intensity then radiosurgery and are delivered over a longer period of 6-7 weeks. Advanced radiotherapy techniques, such as Intensity Modulated Radiotherapy (IMRT), Volumetric Arc Therapy (VMAT) or Proton Beam Therapy (PBT) are used nowadays to deliver targeted radiotherapy. Compared to radiotherapy a few decades ago, these techniques cause fewer side effects and may be more effective.





 

Our Lung Radiosurgery Specialist

AARO Dr David Tan Lung Cancer

Dr David Tan Boon Harn

View Dr David Tan's profile here.

 

Consultant Radiation Oncologist 

MBBS (Sin), FRCR (Clinical Oncology, UK)

FAMS (Radiation Oncology)

Clinical Interest:

Lung Stereotatic Ablative Radiosurgery (SABR)

Lung Cancers & GI, Gynaecology, Brachytherapy

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