Stereotactic Body Radiation Therapy Is Effective and Safe in Patients with Early-Stage Non-Small Cell Lung Cancer with Low Performance Status and Severe Comorbidity

Abstract

Background: The purpose of this study was to assess stereotactic body radiation therapy (SBRT) results and toxicity for stage I non-small cell lung cancer patients with low performance status and severe comorbidity. Patients and Methods: From September 2008 to April 2010, 36 patients with 38 lesions were treated with hypofractionated SBRT. All except one were medically inoperable, had low performance status and/or severe cardiovascular and/or cardiopulmonary comorbidity. The patients were immobilized in an Elekta stereotactic body frame to improve setup accuracy, and four-dimensional CT scans were used for target delineation. Fractions of 15 Gy were prescribed to cover the planning target volume, giving a total dose of 45 Gy, with 1 fraction every second day. Cone beam CT was applied at each fraction to correct for setup errors. The patients were followed with toxicity evaluation and radiographic follow-up. Results: Median follow-up time was 13.8 months (0–21 months). The local tumor control after 12 months was 100%. Four patients developed regional relapse about 12 months after SBRT. The 1-year disease-free survival was 83%. The median tumor shrinkage at 1 year was 22 mm. Three patients experienced systemic relapse after 13 months. One patient developed grade 3 chest pain toxicity and 16 patients reported temporary grade 1 chest pain toxicity. Two patients reported temporary increased dyspnea. No patient experienced a reduction of the performance status after SBRT. Conclusion: SBRT is an effective and safe treatment modality for elderly patients with early-stage non-small cell lung cancer, having low performance status and severe comorbidity. It is possible to achieve high local control rates with good tolerance.

Use of stereotactic body radiation therapy for medically inoperable multiple primary lung cancer

“…Stereotactic body radiation therapy (SBRT) for early stage, single lesion, medically inoperable lung cancer has been extensively studied 13–16 with good success and remains a mainstay treatment option for patients who refuse surgery or are determined to be medically inoperable. Only Sinha and McGarry 17 had previously reviewed the use of SBRT for MPLC and determined the technique to be possibly safe and potentially effective in a previous report.…”

Stereotactic Body Radiation Therapy: A Review of Applications and Outcomes

“…The results of her study showed that after a median follow-up period of 16.5 months (range: 3.5-40.7), all but 2 patients demonstrated radiological tumor regression. Eight patients (24%) achieved complete remission [12]. Another study conducted by Hualin Zhang and fellow colleagues assessed survival rates for patients recovering from SBRT for liver cancers.…”

Patient-reported outcomes and functional exercise capacity in a real-life setting in non-small cell lung cancer patients undergoing stereotactic body radiotherapy: the Lung PLUS study

“…The poor survival rates of ES-NSCLC patients who are medically inoperable and treated with SBRT can be attributed to the fact that this patient population is often older, has multiple severe co-morbidities and a low performance status, as reported in previous studies (4). Although population-based and randomized controlled studies have proven the benefit of SBRT, the extent of this benefit in frail patients is frequently questioned (5,6).…”