Long term outcome after 48 Gy stereotactic ablative body radiotherapy for peripheral stage I non-small cell lung cancer

Abstract

Background To evaluate the outcome of patients treated with stereotactic ablative body radiotherapy (SABR) with curative intent for stage I non-small cell lung cancer (NSCLC) with regard to local, regional and distant tumor control, disease-free survival (DFS), overall survival (OS) and toxicity. Methods Data of 300 patients treated with SABR for NSCLC cancer for the period of November 2007 to June 2016 were retrospectively analyzed. Of which, 189 patients had single primary lung lesion and were included in the study. The prescribed dose for the tumor was 48 Gy, given in 12 Gy × 4 fractions for all patients. In 2010, an improved protocol was established in advanced technology for the planning CT, dose calculation and imaging. Cumulative incidence function (CIF) of local, regional, distant or any recurrences were computed using competing risk analysis with death as a competing event. Survivals (DFS and OS) were estimated using the Kaplan-Meier method and Cox proportional regression was used for comparisons. Toxicities were graded according to the common terminology criteria for adverse events version 4.0 (CTCAE v.4). Results Diagnosis was histologically confirmed in 42% of the patients ( N = 80). At 1, 2 and 4 years, the cumulative incidence function (CIF) of local relapses were 8% [4–13%], 15% [10–21%] and 18% [12–25%], the CIF of regional relapses were 4% [2–8%], 10% [6–16%] and 12% [8–19%], the CIF of distant relapses were 9% [5–14%], 15% [11–22%] and 20% [15–28%] and the CIF of any relapses were 14% [10–20%], 28% [22–36%], 34% [27–43%], respectively. After 1, 2 and 4 years, the OS rates were 83% [95% CI: 78–89%] ( N = 128), 65% [95% CI: 57–73%] ( N = 78) and 37% [95% CI: 29–47%] ( N = 53), respectively. The median survival time was 37 months. The DFS after 1, 2 and 4 years reached 75% [95% CI: 68–81%] ( N = 114), 49% [95% CI: 42–58%] ( N = 60) and 31% [95% CI: 24–41%] ( N = 41), respectively. No grade 4 or 5 toxicity was observed. Conclusions We observed a long-term local control and survival after SABR for peripheral stage I NSCLC in this large series of patients with the expected low toxicity.

First-site-metastasis pattern in patients with inoperable stage III NSCLC treated with concurrent chemoradiotherapy with or without immune check-point inhibition: a retrospective analysis

“…In the past decade, important advances have been achieved in the multimodal treatment of inoperable stage III NSCLC. The introduction of VMAT has decreased the toxicity of TRT [ 20 – 22 ] and routine concurrent chemo-radiotherapy has constantly been improved [ 23 ]. The PACIFIC trial has changed the landscape of thoracic oncology with unprecedented improvements in OS and PFS [ 7 , 8 , 24 ].…”

SABR-BRIDGE: Stereotactic ABlative Radiotherapy Before Resection to AvoId Delay for Early-Stage LunG Cancer or OligomEts During the COVID-19 Pandemic

“…A number of prospective, multicenter clinical trials have demonstrated excellent local control of early-stage NSCLC with minimal levels of acute and late toxicity using a variety of fractionation options including 54–60 Gy in three fractions, 48 Gy in four fractions, and 30–34 Gy in one fractions for tumors which are located peripherally (outside of 2 cm from the proximal bronchial tree) ( 24 – 27 ) SABR is also feasible to deliver to tumors which are located within 2 cm of the proximal bronchial tree (central or ultracentral tumors), through the use of more cautious dose fractionation options including 60 Gy in eight fractions and 50 Gy in five fractions ( 28 , 29 ).…”

Undertreatment or overtreatment – how far from each other in geriatric oncology?

“…Dose-volume limits need to be identified to predict complications involving central structures such as the proximal airways, heart, esophagus, and great vessels, especially in older patients (24). SABR provides a long-term local control and survival for peripheral stage I NSCLC with a low toxicity (25).…”