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