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World J Clin Oncol. Feb 24, 2022; 13(2): 101-115
Published online Feb 24, 2022. doi: 10.5306/wjco.v13.i2.101
Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor: A new paradigm?
Castalia Fernández, Arturo Navarro-Martin, Andrea Bobo, Joaquín Cabrera-Rodriguez, Patricia Calvo, Rodolfo Chicas-Sett, Javier Luna, Nuria Rodríguez de Dios, Felipe Couñago
Castalia Fernández, Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
Arturo Navarro-Martin, Department of Radiation Oncology, Institut Catalá d’Oncologia, L’Hospitalet de Llobregat, Barcelona 08908, Spain
Andrea Bobo, Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
Joaquín Cabrera-Rodriguez, Department of Radiation Oncology, Hospital Universitario de Badajoz, Badajoz 06080, Spain
Patricia Calvo, Department of Radiation Oncology, Hospitalario Clínico Universitario de Santiago de Compostela, Santiago de Compostela 15706, Spain
Rodolfo Chicas-Sett, Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
Javier Luna, Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
Nuria Rodríguez de Dios, Department of Radiation Oncology, Hospital del Mar, Barcelona 08003, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
Felipe Couñago, Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
Author contributions: All authors contributed to this paper with conception and design of the manuscript, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: The authors declare having no conflicts of interests related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Castalia Fernández, MD, Staff Physician, Department of Radiation Oncology, GenesisCare Madrid, Emilio Vargas 16, Madrid 28043, Spain.
Received: February 27, 2021
Peer-review started: February 27, 2021
First decision: May 7, 2021
Revised: June 7, 2021
Accepted: January 24, 2022
Article in press: January 24, 2022
Published online: February 24, 2022

Stereotactic ablative body radiotherapy (SABR) is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer (NSCLC) and pulmonary metastasis. Several fractionation schemes have proven to be safe and effective, including the single fraction (SF) scheme. SF is an option cost-effectiveness, more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments. The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm, recommending this option to minimize patients’ visits to hospital. SF SABR already has a long experience, strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases, making it a valid treatment option; although its use in central locations, synchronous and recurrencies tumors requires more prospective safety and efficacy studies. The SABR radiobiology study, together with the combination with systemic therapies, (targeted therapies and immunotherapy) is a direction of research in both advanced disease and early stages whose future includes SF.

Keywords: Stereotactic body radiotherapy, Sterotactic ablative body radiotherapy, Radiosurgery, Non-small cell lung cancer, Lung cancer, Lung metastases

Core Tip: There is strong evidence (two phase II prospective studies) to support using single-fraction stereotactic ablative body radiotherapy schemes in early stage peripheral non-small cell lung cancer. In pulmonary oligometastatic disease, there are promising outcomes and publication of one randomized prospective phase II study is pending. The association of this scheme with new systemic therapies looks promising for the future.