Definitive Treatment of Early-Stage Non-Small Cell Lung Cancer with Stereotactic Ablative Body Radiotherapy in a Community Cancer Center Setting

Abstract

IntroductionStereotactic ablative body radiotherapy (SABR) provides a superior non-small cell lung cancer (NSCLC) treatment option when compared to conventional radiotherapy for patients deemed inoperable or refusing surgery. This study retrospectively analyzed the rates of tumor control and toxicity following SABR treatment (Cyberknife system) of primary early-stage NSCLC in a community setting.MethodsOne hundred patients were treated between 2007 and 2011. Patients with T3-4 or N1-3 disease, metastasis, recurrent local disease, or a non-lung primary were excluded from analysis. All patients had biopsy proven disease. Staging included CT or fluorodeoxyglucose-positron emission tomography scan. Median dose was 54 Gy (45–60); 18 Gy (10–20) per fraction. Median planned target volume expansion was 8 mm (2–10). Median BED was 151.2. Tumors were tracked via Synchrony, X-Sight Lung, or X-Sight Spine. Patients were evaluated for local control, overall survival (OS), and toxicity. All local failures were determined by evaluating post treatment PET/CT.ResultsWith a median follow up of 27.5 months, the 1-, 2-, and 3-year local control rates were 100, 93.55, and 84.33%, respectively. Median survival was 2.29 years; actuarial 3-year survival was 37.20%. Grade-3 toxicity was observed in 2% of patients (pneumonia within 2 months of treatment, n = 1; chronic pneumonitis requiring hospital admission, n = 1). No patients demonstrated toxicity above Grade-3. Multivariate analysis did not show T-stage as an independent predictor of OS, though it did trend toward significance.ConclusionIn a community-center setting, definitive treatment of NSCLC with SABR for non-surgical candidates and those who choose to forego surgery result in excellent and comparable rates of local control and toxicity compared to published series from large academic centers.

A phase I/II study on stereotactic body radiotherapy with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm for lung tumors

“…Representative results for PTV planning target volume Conformity index prescribed isodose volume (PIV)/target volume (TV), homogeneity index maximum dose within the TV/prescribed dose, according to RTOG [21], the Paddick conformity index (TV covered by the prescribed isodose volume) 2 /(TV × PIV) [22] a Homogeneity and conformity indices were calculated according to the Radiation Therapy Oncology Group 1993 criteria [21] and the conformity number was also calculated according to the Paddick conformity index (conformity number) [22] b Percentage of the lung volume, excluding the gross tumor volume, receiving 20 (5) Table 5 [23][24][25]. In our phase I/II study, the incidence of adverse events was low and short-term efficacy appeared good, compared to those in other studies.…”

Systematic Endobronchial Ultrasound-guided Mediastinal Staging Versus Positron Emission Tomography for Comprehensive Mediastinal Staging in NSCLC Before Radical Radiotherapy of Non-small Cell Lung Cancer

“…Higher than expected regional LN failure rates are seen in patients receiving SABR in which staging was performed on the basis of PET alone, with the authors suggesting these outcomes indicate the potential utility of minimally invasive EBUS-TBNA for LN staging before radiation therapy. 37 …”

Survival After Stereotactic Body Radiation Therapy for Clinically Diagnosed or Biopsy-Proven Early-Stage NSCLC: A Systematic Review and Meta-Analysis

“…The pooled estimate for 5-year OS for biopsy-proven disease (n ¼ 8101) was not significantly different 17,19,25,27,28,[32][33][34][35]38,39,41,42,[44][45][46][48][49][50]52,53,55,59 respectively (Fig 3). For 3-year OS, there was no difference between clinical disease 19 21,26,30,31,36,40,46,49,51,54,56,58,59 for biopsy-proven disease (n ¼ 998 and n ¼7249), respectively.…”