Elsevier

Radiotherapy and Oncology

Volume 101, Issue 2, November 2011, Pages 245-249
Radiotherapy and Oncology

SBRT of lung cancer
Stereotactic radiotherapy of histologically proven inoperable stage I non-small cell lung cancer: Patterns of failure

https://doi.org/10.1016/j.radonc.2011.06.009Get rights and content

Abstract

Background and purpose

To report patterns of failure of stereotactic body radiation therapy (SBRT) in inoperable patients with histologically confirmed stage I NSCLC.

Materials and methods

Ninety-two inoperable patients (median age: 75 years) with clinically staged, histologically proven T1 (n = 31) or T2 (n = 61), N0, M0 non-small cell lung cancer (NSCLC) were included in this study. Treatment consisted of 3–5 fractions with 7–15 Gy per fraction prescribed to the 60% isodose.

Results

Freedom from local recurrence at 1, 3 and 5 years was 89%, 83% and 83%, respectively. All 10 local failures were observed in patients with T2 tumors. Isolated regional recurrence was observed in 7.6%. The crude rate of distant progression was 20.7%. Overall survival at 1, 3, and 5 years was 79%, 38% and 17% with a median survival of 29 months. Disease specific survival at 1, 3, and 5 years was 93%, 64% and 48%. Karnofsky performance status, T stage, gross tumor volume and tumor location had no significant impact on overall and disease specific survival. SBRT was generally well tolerated and all patients completed therapy as planned.

Conclusion

SBRT for stage I lung cancer is very well tolerated in this patient cohort with significant cardiopulmonal comorbidity and results in excellent local control rates, although a considerable portion develops regional and distant metastases.

Section snippets

Patient eligibility

Patients with histologically proven NSCLC (cT1-2 cN0 cM0, i.e. stage I) not suitable for surgery for medical or functional reasons were included in this retrospective mono-institutional analysis. All patients assigned to receive SBRT were referred by pulmologists or thoracic surgeons and discussed in a multidisciplinary tumor board. Pretreatment investigations in all patients included physical examination, pulmonary function tests, computed tomography (CT) scan of the thorax and abdomen with

Results

From December 2000 to March 2010, 92 patients with histologically proven stage I NSCLC were treated with SBRT. All patients completed their treatment as planned. The median follow-up was 21 months. At the time of analysis, 59 patients had died (64%). Patient and treatment characteristics are summarized in Table 1. PET-based staging was not mandatory but recommended, and performed in 77 patients. Baseline spirometry data were available in 80 patients (87%) with a median forced expiratory volume

Discussion

In this large mono-institutional series we found an excellent local tumor control rate after SBRT for patients with stage I NSCLC who were not eligible for surgery and clearly presented with adverse prognostic features such as median age of 75 years and KPS of 70. With regard to a maximum follow-up of 87 months (median 21 months) and given the fact that all local recurrences occurred within 19 months, it is reasonable to conclude that SBRT can provide durable local tumor control and potential cure.

Conclusions

With regard to the high local control rate and the low risk of serious therapy-associated toxicity SBRT with currently established fractionation regimens offers an attractive alternative to surgery and should be the preferred treatment for stage I NSCLC patients not eligible for resection.

Conflict of interest

None.

Acknowledgements

This work was supported by generous financial aid from the “Bavarian State Ministry of Environment, Public Health and Consumer Protection”. We thank Barbara Hofbauer, Assistant to the Head of Department, for her help in preparing the manuscript.

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