SABR-BRIDGE: S tereotactic AB lative R adiotherapy B efore R esection to Avo I d D elay for Early-Stage Lun G Cancer or Oligom E ts During the COVID-19 Pandemic

Biniam Kidane; Jonathan Spicer; Julian O Kim; Pierre-Olivier Fiset; Bassam Abdulkarim; Richard Malthaner; David Palma

doi:10.3389/fonc.2020.580189

SABR-BRIDGE: S tereotactic AB lative R adiotherapy B efore R esection to Avo I d D elay for Early-Stage Lun G Cancer or Oligom E ts During the COVID-19 Pandemic

Front Oncol. 2020 Sep 25:10:580189. doi: 10.3389/fonc.2020.580189. eCollection 2020.

Authors

Biniam Kidane^{1

2

3}, Jonathan Spicer^{4

5}, Julian O Kim^{3

6}, Pierre-Olivier Fiset⁷, Bassam Abdulkarim⁸, Richard Malthaner^{9

10}, David Palma^{10

11}

Affiliations

¹ Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
² Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
³ Research Institute in Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada.
⁴ Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
⁵ Research Institute of the McGill University Health Center, Montreal, QC, Canada.
⁶ Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁷ Department of Pathology, McGill University, Montreal, QC, Canada.
⁸ Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, QC, Canada.
⁹ Division of Thoracic Surgery, Department of Surgery, Western University, London, ON, Canada.
¹⁰ Lawson Health Research Institute, London, ON, Canada.
¹¹ Division of Radiation Oncology, Western University, London, ON, Canada.

Abstract

Surgical resection is the standard-of-care approach for early-stage non-small cell lung cancer (NSCLC). Surgery is also considered an acceptable standard infit patients with oligometastatic lesions in the lungs. The COVID-19 pandemic has led to worldwide issues with access to operating room time, with patients and physicians facing uncertainty as to when surgical resection will be available, with likely delays of months. Further compounding this are concerns about increased risks of respiratory complications with lung cancer surgery during active phases of the pandemic. In this setting, many thoracic oncology teams are embracing a paradigm where stereotactic ablative radiotherapy (SABR) is used as a bridge, to provide radical-intent treatment based on a combination of immediate SABR followed by planned surgery in 3-6 months. This pragmatic approach to treatment has been named SABR-BRIDGE (Stereotactic ABlative Radiotherapy Before Resection to avoId Delay for early-stage lunG cancer or oligomEts). This term has also been applied to the pragmatic study of the outcomes of this approach. In this paper, we discuss the standards of care in treatment of early-stage (NSCLC) and pulmonary oligometastases, the impetus for the SABR-BRIDGE approach, and the controversies surrounding assessment of pathological response to neo-adjuvant radiation therapy.

Keywords: COVID-19; SABR lung; SBRT (stereotactic body radiation therapy); lobectomy (lung); lung cancer; nonsmall cell lung cancer; pulmonary metastases; sublobar pulmonary resection.

Publication types

Review