To test or to treat.
Top Line: Sometimes empiric stereotactic body radiation (SBRT) for early-stage lung cancer is performed when biopsies are deemed too risky.
The Study: So how risky are biopsies, anyway? Physicians in Switzerland and the low countries have their own take on recent ASCO/ASTRO guidelines on the treatment of early-stage lung cancer. The summary of it all is that those with standard operable risk should not receive SBRT as an alternative to surgery unless it is on a clinical trial. If nothing else, this has generated some lively twitter feeds that all circle back to the same debate: Is SBRT truly less effective and/or less safe than standard lobectomy? Haters cite wack lung SBRT cohorts that include several clinical (as opposed to pathologic) diagnoses when biopsies were deemed too risky, cleverly pointing out that patients too sick to biopsy should be too sick to treat. Right on cue, this national claims data analysis aims to quantify the risk associated with tissue attainment for the work-up of a radiographic lung abnormality. Among nearly 175K patients undergoing some form of lung biopsy, the rate of any complication was 22% for younger and 24% for older patients. These were well-stratified by procedure with rates of 19% among needle biopsies, 36% among bronchoscopies, and a whopping 52% among excisional biopsies.
Bottom Line: As crazy as it sounds, empiric lung SBRT may in fact be the safest bet for high-risk patients with high-risk lesions. | Guckenberger, J Thorac Cardiovasc Surg 2019 & Huo, JAMA Intern Med 2019
The Study: So how risky are biopsies, anyway? Physicians in Switzerland and the low countries have their own take on recent ASCO/ASTRO guidelines on the treatment of early-stage lung cancer. The summary of it all is that those with standard operable risk should not receive SBRT as an alternative to surgery unless it is on a clinical trial. If nothing else, this has generated some lively twitter feeds that all circle back to the same debate: Is SBRT truly less effective and/or less safe than standard lobectomy? Haters cite wack lung SBRT cohorts that include several clinical (as opposed to pathologic) diagnoses when biopsies were deemed too risky, cleverly pointing out that patients too sick to biopsy should be too sick to treat. Right on cue, this national claims data analysis aims to quantify the risk associated with tissue attainment for the work-up of a radiographic lung abnormality. Among nearly 175K patients undergoing some form of lung biopsy, the rate of any complication was 22% for younger and 24% for older patients. These were well-stratified by procedure with rates of 19% among needle biopsies, 36% among bronchoscopies, and a whopping 52% among excisional biopsies.
Bottom Line: As crazy as it sounds, empiric lung SBRT may in fact be the safest bet for high-risk patients with high-risk lesions. | Guckenberger, J Thorac Cardiovasc Surg 2019 & Huo, JAMA Intern Med 2019
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