The Presidential primary election season has been eye-opening, with outcries by candidates from both parties of a “rigged system”. The “establishment” has recoiled from such talk. But shining the light on “the accepted way” of doing things has made all Americans more aware of the pitfalls of the system. And asking probing questions is never bad.
It’s taken two lung cancer specialists from “Down Under” at the MacCallum Cancer Center in Australia to shine the light on the lung cancer surgery establishment in America. In a thoughtful review of the existing studies of stereotactic ablative body radiation therapy (SABR) versus lung surgery, Dr. Siva and Dr. Ball make a compelling case for the use of SABR to treat early stage non-small cell lung cancer patients. Dr. Siva and Dr. Ball conclude “SABR and surgery had similar estimated overall and disease-free survival.” Their study was recently published in the prestigious journal, The Oncologist 2016; 21:1-6.
The situation is exactly the same as 30 years ago when I started training in radiation oncology at Harvard. The raging controversy at that time was lumpectomy and radiation therapy versus mastectomy. Despite study after study showing that lumpectomy and radiation was exactly the same as mastectomy, the vast majority of early stage breast cancer patients still underwent mastectomy. But it’s always been hard to get surgeons to tell patients about surgical alternatives for early stage cancers, whether it’s breast cancer or lung cancer.
Did you know that only 14 of 50 states in America require that physicians inform early stage breast cancer patients of lumpectomy and radiation as an alternative to mastectomy? Any wonder that those same states have more women undergoing radiation and lumpectomy than surgery?
Do you know how many states require that doctors tell early stage non-small cell lung cancer patients of using stereotactic ablative body radiation, or SABR for short, to cure early stage lung cancer versus surgery? Exactly 0! Any wonder that many early stage lung cancer patients have never even heard of stereotactic ablative body radiation (SABR), like that delivered by Cyber Knife? Or that the information given to them was inaccurate or incomplete?
Dr. Michael Steinberg and colleagues from UCLA looked at 102 early stage non-small cell lung cancer patients treated with stereotactic radiation (SABR)-56% had no prior knowledge of SABR before meeting a radiation oncologist. Among those 102 patients, 39 patients had prior lung surgery for a previous lung cancer. And 90% of those patients would rather have had stereotactic ablative body radiation, like that delivered by Cyber Knife, than another lung surgery (Lung Cancer 2015; 90:230-233).
So what’s an early stage lung cancer patient to do? I have a modest proposal. Early stage lung cancer patients need to be “difficult patients.” All of us doctors know the type – asking a lot of questions, having many family members present, and coming armed with a lot of facts found on the Internet. Challenging your physician can sometimes be a good thing.
So if you have any questions on your early stage non-small cell lung cancer, please feel free to call me, Dr. Edward Hughes at 855-DAYTON1