Stereotactic body radiation therapy (SBRT) in the treatment of Neuroendocrine Neoplasms

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What is Stereotactic Body Radiation Therapy (SBRT)?

External beam radiotherapy has been around for a while. But the next generation equipment and techniques are gradually being deployed.   It’s a confusing area with many synonyms which I found when I wrote about the subject in a treatment summary for patients.  Some of the sub-components/synonyms may be familiar to you and are often used interchangeably with SBRT; but are actually a brand name (e.g.Cyberknife) or a type (e.g. Proton Beam). 

You will not find SBRT mentioned in any Neuroendocrine Neoplasms (NENs) guidelines and that’s because it is not a “standard of care” for this disease.

If it is not a standard of care, why did I include SBRT and various techniques in the above summary?  I was prompted to include this after noticing two things in my private patient group.  Firstly, some patients had received the treatment, and secondly because many people are asking if was “approved” for use in NENs.  

This type of therapy is often called Stereotactic radiosurgery (SRS) when used to treat brain tumours.  SBRT gives radiotherapy from many different angles around the body. The beams meet at the tumour. This means the tumour receives a high dose of radiation and the tissues around it receive a much lower dose. This lowers the risk of side effects.  This type of radiotherapy is mainly used to treat small cancers, 

Like conventional surgery, there is a focus on the anatomy so when you look at big sites such as Mayo Clinic, you can see SBRT is used to treat tumors in the lungs, spine, liver, neck, lymph node or other soft tissues.  So, they may not specify particular cancer types, only the locations of tumours.  That said, there are many clinical trials going on where cancer types are mentioned. On the NIH database, I found 1235 with the term “SBRT” and narrowed that down to 20 with both SBRT and Neuroendocrine Tumours (note: filtering is not an exact science!)

Within the space of one month at the beginning of 2023, two studies came up on my radar involving SBRT and NETs.  One for functional pancreatic NETs and the other covering Lung NETs.  Both are covered below. 

SBRT for functional pancreatic NETs

I was following a Twitter thread where they were discussing options (e.g. ablation) for treating small pancreatic NETs where anything below 2cm.  Guidelines currently indicate that for pancreatic NETs less than 2cm, not threatening major vessels and or non-functional, should be observed.  Inside the discussion, a leading hepatobiliary surgeon shared this Proof-of-Concept study of SBRT for functional NENs.  A proof of concept can be simply defined as evidence that demonstrates that a concept is feasible (in some ways a precursor to a clinical trial). 
As many of you will be aware, hormonal syndromes related to functional NEN represent a significant management challenge. Surgery is a standard of care, but it can be associated with short and long-term postoperative morbidity and may not be appropriate for all patients.

The study attached is small but interestingly contains feedback on 4 subjects.  Three of them involve functional pancreatic NETs (Glucagonoma, Insulinoma, multifocal * Insulinoma with MEN1) and a Lung NET with Ectopic Cushing’s Syndrome. * more than one distinct tumour.

Myrehaug S, Hallet J, Chu W, Yong E, Law C, Assal A, Koshkina O, Louie AV, Singh S. Proof of concept for stereotactic body radiation therapy in the treatment of functional neuroendocrine neoplasms. J Radiosurg SBRT. 2020;6(4):321-324. PMID: 32185093; PMCID: PMC7065890.

Click anywhere on the title in blue above to read more.

SBRT for early-stage Lung NETs

Researchers have found that stereotactic body radiotherapy (SBRT) may be an effective treatment for patients with early-stage lung neuroendocrine tumors, according to a new study published by Oliver et al in the International Journal of Radiation Oncology • Biology • Physics (subscription only)

The abstract I read came from the American Society of Clinical Oncology (ASCO) who said the conclusion of the study stated “The current study is the largest and first multi-institutional series evaluating local control, toxicity, and dosimetric outcomes with SBRT for early-stage lung neuroendocrine tumors. Our results suggest that while surgery provides excellent outcomes, SBRT should be considered [as] another treatment option for this patient population,” concluded senior study author Stephen Rosenberg, MD, Assistant Member of the Section of Thoracic Oncology and Director of Magnetic Resonance Imaging–Guided Radiotherapy in the Department of Radiation Oncology at the Moffitt Cancer Center.

Read the ASCO abstract by clicking here

Disclaimer

I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me. 

Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.   

Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.

General Clinical Trials Disclaimer

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided in the clinical trials document. It’s very important to check the trial inclusion and exclusion criteria before making any contact.  If you need questions, the articles here is very useful Questions to Ask About Clinical Trials | Cancer.Net

The inclusion of any trial within this blog should not be taken as a recommendation by Ronny Allan. 

 
 

Thanks for reading.

Ronny

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