8542 Background: SBRT is a well-established, highly efficacious treatment for T1N0 non-small cell lung carcinoma (NSCLC). Its efficacy in T2N0 cancers is less clear. This is a review of our institutional experience with long-term follow-up. Methods: 45 patients with medically inoperable T2 N0/Nx M0 NSCLC who were treated with definitive SBRT between 2009 and 2013 were analyzed retrospectively. All patients underwent PET/CT staging and fiducial marker placement for image guided therapy with the Cyberknife platform. Radiation dose was 50 Gray in 5 fractions (N = 24), 50 Gray in 4 fractions (N = 11) or 54-60 Gray in 3 fractions (N = 10) delivered over 7 to 14 days. We analyzed overall survival from the date of start of SBRT, and we performed analyses actuarially using Cox regression analysis and Kaplan-Meier survival analysis for comparisons of hazard ratio (HR) among subgroups. Results: 45 patients were studied (median age 74). The 5-year actuarial overall survival was 18.7% (39.3% at 2 years), with most patients dying from lung cancer recurrence/progression outside of the treatment field. Subgroup analyses showed no statistically significant differences with respect to age, gender, histology, nominal radiation prescription dose, tumor diameter or PTV target volume (median PTV 87cc). There was statistically significantly better survival associated with increased maximum biologically effective dose (BED10) of radiation at the center of the tumor (p = 0.03). Conclusions: Unlike the outcomes for T1 NSCLC, our results in T2 NSCLC were disappointing, with a high rate of out-of-field failure and death from lung cancer. We stress the importance of diagnosis and treatment of NSCLC at the T1N0 stage. We suggest that patients with T2N0/Nx NSCLC be considered for SBRT dose intensification and/or combined modality therapy protocols.

Conclusion: Patients with a decrease in SMI after definitive chemoradiotherapy have a poor prognosis. This data may allow for the selection of patients who may benefit from the integration of additional systemic therapy, closer surveillance, or nutritional optimization after definitive chemoradiotherapy.

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were treated. The medium volume was 22,49cc (range 2,76-64,9cc).Seven lesions received only one fraction of radiotherapy, 3 lesions (12%) received 23 Gy and 4 lesions (17%) received 30 Gy. Seventeen lesions received multiple fractions. Seven lesions (29%) received 45 Gy in 3 fractions, 6 lesions (25%) received 48 Gy in 8 fractions and 4 lesions (17%) received 50 Gy in 5 fractions. Previous treatment included SBRT; eleven lesions were treated with one fraction of SBRT, 2 lesions (10%) with 23 Gy and 9 lesions (43%) with 30 Gy. Six lesions (28%) received multiple fraction of SBRT: 50 Gy in 5 fractions. Three lesions (14%) received a radical course of RT, 60 Gy in 20 fractions and 1 lesion (5%) received a course of adjuvant RT, 50 Gy in 25 fractions. The median interval from the first treatment and re-irradiation was 18 months (range 3-66 months). Results: The LC was reached in 17 out of 24 lesions re-irradiated (71%), the progression free survival (PFS) was detected in 8 out of 18 patients (44%). The median interval of PFS was 9 months (range 1-42 months). The median interval of overall survival was 12 months (range 1-54 months). At last follow up there were 13 out of 18 patients (72%) alive. The median follow-up for patients alive was 12 months (range 1-39 months). Acute toxicities were: dyspnea G1 in 2 patients (11%), 1 patients (5%) had dyspnea G2, 1 patient (5%) had retrosternal pain, 1 patient (5%) had hemoptysis G1, 1 patient (5%) had sensory neuropathy G2 and neuralgia G1, 1 patient (5%) had productive cough G2 and 1 patient (5%) had dry cough G1. Late toxicities were dyspnea G1 in 1 patient (5%), dyspnea G3 in 2 patients (11%), one of this had also, asthenia, pulmonary fibrosis G2 and rib fracture. One patient (5%) had chest wall pain, 2 patients (11%) had pulmonary fibrosis G1, and one of this had also pneumothorax G2. One patient (5%) had pulmonary fibrosis G2 and pleural effusion G1. One patient (5%) had perilesional necrosis of soft tissues. Conclusion: Re-irradiation of primary or secondary disease in the lung is a feasible option of treatment. We obtained good results in terms of LC, PFS and OS, with acceptable toxicity. Further studies occur to identify the doses and the best fractionation, according to the volume and the localization of the lesion.