Definitive radiotherapy for stage I nonsmall cell lung cancer

Abstract

BACKGROUND:The current study characterizes the overall survival (OS) and cause-specific survival (CSS) of patients with stage I nonsmall cell lung cancer (NSCLC) who were treated with radiotherapy alone, and analyzes the variables potentially affecting survival outcomes. METHODS: A total of 8524 patients with stage I NSCLC (according to the sixth edition of the American Joint Committee on Cancer staging manual) who were diagnosed between 1988 and 2008 were retrospectively analyzed using the population-based Surveillance, Epidemiology, and End Results database. Cox regression analysis was used to calculate hazard ratios (HR) from multivariate analyses. RESULTS: The 1-year, 2-year, and 5-year OS rates were 62%, 37%, and 11%, respectively; the corresponding lung cancer CSS survival rates were 68%, 45%, and 20%, respectively. Approximately 77% of deaths were from lung cancer (5292 of 6891 total deaths). Cardiac (n ¼ 477 deaths) and pulmonary (other than lung cancer deaths; n ¼ 475 deaths) deaths accounted for 14% of deaths. From Cox proportional hazards analyses, male sex (HR, 1.2) and squamous cell carcinoma histology (HR, > 1.1) were found to be significantly (P < .0001) adverse prognostic factors for both OS and lung cancer CSS. A more recent calendar year of diagnosis was associated with significantly (P < .0001) improved OS (HR, 0.84 per decade) and lung cancer CSS. This trend was also significant (P < 0.0001) when restricting analyses to those patients with tumors measuring 5 cm (n ¼ 5402 patients). T1 classification (vs T2 or T unknown) and smaller tumor size were found to be significantly (P < .0001) favorable factors. CONCLUSIONS: From a population-based registry analysis of patients with stage I NSCLC, significant (albeit modest) improvements in survival in more recent years were appreciated, which likely reflect technologic advances in the diagnosis of, staging of, and radiotherapy for NSCLC. Cancer 2012;118:5572-9.

Comparison of Single- and Three-fraction Schedules of Stereotactic Body Radiation Therapy for Peripheral Early-stage Non–Small-cell Lung Cancer

“…This finding is consistent with past studies. 19,[29][30][31] However, increasing tumor size was not associated with higher local, nodal, or distant failure rates in our study, which contrasts with those reported previously. [22][23][24] This observation may be in part due to having a small sample size of those with T2 diseases in our analysis, only 20-24% of patients in each cohort.…”

Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors

“…Local progression in our series occurred in 4 (9%) tumors after a median time of 14 months: 3 out of 4 of these occurred in lesions >25 mm, which can represent a threshold of effectiveness and can be used to select early-stage NSCLCs’ best population suitable for the treatment with 30 Gy SBRT. It is known that smaller lesions respond better to SBRT 1,25–28 , but no studies, to data, have assessed dimensional prognostic factors of response after 30 Gy SBRT in this setting. Moreover some controversies exist regarding the definition of local failure, since some authors define it as any relapse within the same lobe and/or of the treated lesions 7,29 , while others consider it as the sole failure of the treated lesion 30,31 and this can complicate the comparison and interpretation of the results.…”

Recent Advancements in Minimally Invasive Surgery for Early-Stage Non-Small Cell Lung Cancer: A Narrative Review

“…Patients who are medically unable to undergo surgery for early-stage NSCLC are usually treated with radical radiotherapy. However, when standard fractionation is used, the outcomes are not as good as surgery, with 5-year OS rates of only 11% [71]. On the other hand, using stereotactic ablative radiotherapy (SABR) has shown similar local control rates and disease-specific survival rates to surgery [72].…”