Clinical results of stereotactic body radiotherapy for Stage I small-cell lung cancer: a single institutional experience

Abstract

The purpose of this study was to evaluate the treatment outcomes of stereotactic body radiotherapy (SBRT) for Stage I small-cell lung cancer (SCLC). From April 2003 to September 2009, a total of eight patients with Stage I SCLC were treated with SBRT in our institution. In all patients, the lung tumors were proven as SCLC pathologically. The patients' ages were 58–84 years (median: 74). The T-stage of the primary tumor was T1a in two, T1b in two and T2a in four patients. Six of the patients were inoperable because of poor cardiac and/or pulmonary function, and two patients refused surgery. SBRT was given using 7–8 non-coplanar beams with 48 Gy in four fractions. Six of the eight patients received 3–4 cycles of chemotherapy using carboplatin (CBDCA) + etoposide (VP-16) or cisplatin (CDDP) + irinotecan (CPT-11). The follow-up period for all patients was 6–60 months (median: 32). Six patients were still alive without any recurrence. One patient died from this disease and one died from another disease. The overall and disease-specific survival rate at three years was 72% and 86%, respectively. There were no patients with local progression of the lesion targeted by SBRT. Only one patient had nodal recurrence in the mediastinum at 12 months after treatment. The progression-free survival rate was 71%. No Grade 2 or higher SBRT-related toxicities were observed. SBRT plus chemotherapy could be an alternative to surgery with chemotherapy for inoperable patients with Stage I small-cell lung cancer. However, further investigation is needed using a large series of patients.

The Role of Radiotherapy in Small Cell Lung Cancer: a Revisit

“…Local control was reported as 100 % at 1 year, with no regional nodal failures. Similarly, a series from Japan reported on eight patients treated with lung SBRT, with CHT administered before or after the radiation and without the addition of PCI [14]. The overall and disease-specific survival rates at 3 years were 72 and 86 %, respectively.…”

Stereotactic Radiotherapy for Stage I Small Cell Lung Cancer

“…In one report, eight patients with cT1–2 N0 M0 biopsy-proven SCLC, two of whom refused surgery, underwent SABR (48 Gy in four fractions) [16]. Six patients underwent chemotherapy before ( n = 4) or after ( n = 2) SABR.…”

“…Furthermore, what is the role of prophylactic cranial irradiation (PCI) in these patients, done routinely in both limited- and extensive-stage SCLC owing to OS benefits? Although no data have demonstrated intracranial failure, some institutions have used PCI [17] and others have not [16]. In a study examining the role of PCI in patients with surgically treated SCLC, the authors only noted two of 32 patients (6.25%) developed brain metastases, provided complete surgical resection was performed [21].…”

“…Based on thorough PubMed and EMBASE searches, there have been three published case series, with a total of 22 patients, examining SABR for stage I SCLC. In one report, eight patients with cT1-2 N0 M0 biopsy-proven SCLC, two of whom refused surgery, underwent SABR (48 Gy in four fractions) [16]. Six patients underwent chemotherapy before (n 5 4) or after (n 5 2) SABR.…”

“…What is the optimal timing of chemotherapy with SABR? Published studies [16][17][18] have used neoadjuvant, concurrent, and adjuvant chemotherapy. Furthermore, what is the role of prophylactic cranial irradiation (PCI) in these patients, done routinely in both limited-and extensive-stage SCLC owing to OS benefits?…”