Stereotactic body radiotherapy versus conventional radiotherapy for early-stage small cell lung cancer

Abstract

Purpose: This study was designed to compare survival outcomes for non-surgically managed T1-T2N0M0 small cell lung cancer (SCLC) who received either stereotactic body radiation therapy (SBRT) or conventionally fractionated radiotherapy (CFRT) using the National Cancer Data Base (NCDB). Methods: The was queried between 2004-2015 for patients with T1-T2N0M0 SCLC. Patients must have been treated with curative intent SBRT or CFRT (delivered daily or twice daily, 45-70 Gy) with or without chemotherapy. The primary outcome was overall survival (OS). A subset analysis of patient receiving chemotherapy was also performed. A propensity score matched (PSM) analysis was performed to compare OS among patients who received chemotherapy. Results: We evaluated 1378 patients in the general cohort. Multivariable Cox regression analysis(MVA) in the general cohort revealed that SBRT was significantly associated with improved survival (HR 0.68, p<0.001) along with receipt of chemotherapy (HR 0.63, p <0.001). SBRT patients were less likely to receive chemotherapy compared to CFRT patients (p<0.01). In the chemotherapy subset, of 1096 patients, on MVA, there was a trend in favor of the SBRT group (HR 0.73; p=0.06). A 3:1 PSM analysis on the chemotherapy subset found similar results on MVA with a trend in favor of SBRT (p=0.06). Conclusion: Patients with T1-2N0M0 SCLC treated with SBRT regimens incorporating chemotherapy had comparable outcomes to concurrent chemoradiotherapy using standard fractionation. Treatment paradigms for T1-2N0M0 SCLC incorporating SBRT warrant further exploration and should incorporate chemotherapy.

First-Line Anlotinib Combined with Stereotactic Body Radiation Therapy for an Octogenarian with Pulmonary Carcinosarcoma

“…It has been demonstrated to provide survival benefits superior to conventional fractionated radiotherapy, especially for elderly oligometastatic patients. [8][9][10] There are some reports demonstrates that SBRT might be safe and effective for soft tissue sarcoma. [11][12][13] Huang et al reported a case of an octogenarian with PC treated with SBRT, at a dose of 60 Gy in eight fractions (7.5 Gy per fraction).…”

Stereotactic body radiation therapy for an octogenarian with pulmonary carcinosarcoma

“…SBRT has become an effective treatment modality for medically or surgically inoperable lung cancer, and in one study, it has proven to provide superior survival benefit to the conventional fractionated radiotherapy. 8 Over the past decade, more clinicians have become aware of SBRT and have begun using it more often to treat early-stage lung cancer in both medically inoperable and operable patients. 9,10 It has also been used to treat much older patients (>80 years old) with high efficacy and tolerable toxicities.…”

The current role of surgery and SBRT in early stage of small cell lung cancer

“…SBRT was significantly associated with improved survival when CT was given (P<0.001).On multivariate analysis in the CT group, adjusting for sex, age, and tumor size, the use of SBRT trended to improve survival (P=0.06). SBRT was strongly associated with a survival benefit in elderly patients [121].…”