Feasibility of stereotactic body radiotherapy for locally-advanced non-small cell lung cancer (original) (raw)
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Journal of Radiation Oncology, 2012
Introduction Lung cancer is the most common malignancy worldwide. The standard of care for early stage lung cancer is surgical resection. Patients with this diagnosis frequently have co-morbidities making surgery not feasible. Limited resections result in inadequate disease control. Historic alternatives to surgery such as conventional radiotherapy provide poor outcomes and undue toxicity. Over the past decade, stereotactic body radiotherapy (SBRT) has emerged as a novel radiation modality with significant applications in the medically inoperable, early stage lung cancer population. A range of international retrospective and prospective reports has established SBRT's feasibility, safety and efficacy in these patients using a variety of dose regimens and technologies. Results SBRT results consistently show excellent local control, little acute toxicity, and improved overall survival compared with historical controls of fractionated radiotherapy. Ongoing prospective trials are defining the optimal SBRT regimen in the inoperable population and starting to explore its role for the operable patient.
Journal of Thoracic Oncology, 2013
To evaluate safety and efficacy of stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) in a patterns-of-care and patterns-of-outcome analysis. Methods: The working group "Extracranial Stereotactic Radiotherapy" of the German Society for Radiation Oncology performed a retrospective multicenter analysis of practice and outcome after SBRT for stage I NSCLC. Sixteen German and Austrian centers with experience in pulmonary SBRT were asked to participate. Results: Data of 582 patients treated at 13 institutions between 1998 and 2011 were collected; all institutions, except one, were academic hospitals. A time trend to more advanced radiotherapy technologies and escalated irradiation doses was observed, but patient characteristics (age, performance status, pulmonary function) remained stable over time. Interinstitutional variability was substantial in all treatment characteristics but not in patient characteristics. After an average follow-up of 21 months, 3-year freedom from local progression (FFLP) and overall survival (OS) were 79.6% and 47.1%, respectively. The biological effective dose was the most significant factor influencing FFLP and OS: after more than 106 Gy biological effective dose as planning target volume encompassing dose (N = 164), 3-year FFLP and OS were 92.5% and 62.2%, respectively. No evidence of a learning curve or improvement of results with larger SBRT experience and implementation of new radiotherapy technologies was observed. Conclusion: SBRT for stage I NSCLC was safe and effective in this multi-institutional, academic environment, despite considerable interinstitutional variability and time trends in SBRT practice. Radiotherapy dose was identified as a major treatment factor influencing local tumor control and OS.
Stereotactic body radiotherapy for early stages non-small cell lung cancer
Romanian Journal of Oncology & Hematology, 2013
"For patients with stage I–II Non Small Cells Lung Cancer (NSCLC ) lobectomy remains the standard treatment with 5-year survival rates of about 60–80% for stage I and 40–50% for stage II . For medically inoperable patients (or who decline surgery), with good general medical condition that justifies aggressive local treatment and early localised T1-T2 NoMo NSCLC , the Stereotactic Body Radiation Therapy (SB RT) represents a validated therapeutic option. The SB RT deliver a very high dose per fraction (5 Gy to 34 Gy per fraction) in 1 to 5 total fractions. The minimum Biologically Effective Dose, calculated according to the Linear Quadratic (LQ) model with an α/β value of 10, needed to achieve a local control rate of more than 90%, is 100 Gy. To provide highly accurate, precise, and focused radiation delivery, SBRT requires correct patient immobilization, accurate tumour identification and control of the tumour motion. The radiotherapy regimen choice depends on the tumor localization, central versus peripheral, up to 1 cm or more than 1 cm from the chest wall for peripheral tumours and respectively tumor size. The main critical organs at risk that must be delineated are the spinal cord, oesophagus, heart, chest wall and, for apical tumors, the brachial plexus. Regardless of the technique used, when the biological effective dose (BED ) is >100 Gy, the local control rate is 88-96%. The estimated 3-year primary tumour control rate is more than 90% and the survival probability is 70% at 2 years and more than 55% at 3-years and the most important Grade 3 toxicities are pulmonary (dyspnoea and pneumonitis) and chest pain for peripheral tumours. In conclusion, SB RT is superior to conventionally fractionated radiotherapy and today is the standard of care for medically inoperable and early-localised lung cancer patients."
Stereotactic body radiation therapy for early-stage non-small-cell lung cancer
Expert Review of Anticancer Therapy, 2008
Purpose: The 50-month results of a prospective Phase II trial of stereotactic body radiation therapy (SBRT) in medically inoperable patients are reported. Methods and Materials: A total of 70 medically inoperable patients had clinically staged T1 (34 patients) or T2 (36 patients) (#7 cm), N0, M0, biopsy-confirmed non-small-cell lung carcinoma (NSCLC) and received SBRT as per our previously published reports. The SBRT treatment dose of 60-66 Gy was prescribed to the 80% isodose volume in three fractions. Results: Median follow-up was 50.2 months (range, 1.4-64.8 months). Kaplan-Meier local control at 3 years was 88.1%. Regional (nodal) and distant recurrence occurred in 6 (8.6%) and 9 (12.9%) patients, respectively. Median survival (MS) was 32.4 months and 3-year overall survival (OS) was 42.7% (95% confidence interval [95% CI], 31.1-54.3%). Cancer-specific survival at 3 years was 81.7% (95% CI, 70.0-93.4%). For patients with T1 tumors, MS was 38.7 months (95% CI, 25.3-50.2) and for T2 tumors MS was 24.5 months (95% CI, 18.5-37.4) (p = 0.194). Tumor volume (#5 cc, 5-10 cc, 10-20 cc, >20 cc) did not significantly impact survival: MS was 36.9 months (95% CI, 18.1-42.9), 34.0 (95% CI, 16.9-57.1), 32.8 (95% CI, 21.3-57.8), and 21.4 months (95% CI, 17.8-41.6), respectively (p = 0.712). There was no significant survival difference between patients with peripheral vs. central tumors (MS 33.2 vs. 24.4 months, p = 0.697). Grade 3 to 5 toxicity occurred in 5 of 48 patients with peripheral lung tumors (10.4%) and in 6 of 22 patients (27.3%) with central tumors (Fisher's exact test, p = 0.088). Conclusion: Based on our study results, use of SBRT results in high rates of local control in medically inoperable patients with Stage I NSCLC. Ó 2009 Elsevier Inc.
Radiotherapy and Oncology, 2010
Link to publication in VU Research Portal citation for published version (APA) Palma, D. A. (2011). Stereotactic radiation therapy for stage I non-small cell lung cancer: Measuring outcomes in patients and populations. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Cancers
Surgery is the standard treatment for stage I non-small cell lung cancer (NSCLC); however, no clear randomized trial demonstrates its superiority to stereotactic body radiotherapy (SBRT) regarding survival. We aimed to retrospectively evaluate the treatment outcomes of SBRT in operable patients with stage I NSCLC using a large Japanese multi-institutional database to show real-world outcome. Exactly 399 patients (median age 75 years; 262 males and 137 females) with stage I (IA 292, IB 107) histologically proven NSCLC (adenocarcinoma 267, squamous cell carcinoma 96, others 36) treated at 20 institutions were reviewed. SBRT was prescribed at a total dose of 48–70 Gy in 4–10 fractions. The median follow-up period was 38 months. Local progression-free survival rates were 84.2% in all patients and 86.1% in the T1, 78.6% in T2, 89.2% in adenocarcinoma, and 70.5% in squamous cell subgroups. Overall 3-year survival rates were 77.0% in all patients: 90.7% in females, 69.6% in males, and 41.2...
Stereotactic body radiotherapy in lung cancer: an update
Jornal Brasileiro de Pneumologia, 2015
For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique.
Stereotactic Body Radiation Therapy for Early Non-Small Cell Lung Cancer
Frontiers of Radiation Therapy and Oncology, 2009
For patients with early stage non-small cell lung cancer (NSCLC) unsuitable for resection local high-dose radiotherapy is the treatment of choice. In modern series even with escalated conformal radiotherapy local control rates of about 55% remain disappointing. Within the last years, stereotactic radiotherapy has been shown an effective treatment approach for early stage malignant lung tumors, combining the accurate focal dose delivery by stereotactic techniques with the biological advantages of dose escalated hypofractionated radiotherapy. Typical treatment regimens include three to five fractions over 1-2 weeks or 1 single fraction as radiosurgery. With adequate staging procedures including FDG-PET-CT scan and a low probability of subclinical involvement of unsuspicious locoregional lymph nodes, the concept is to irradiate the primary T1/2 tumor alone. Recent data report local control rates of up to 90%, with favorable results especially for patients in good general condition. Less than 10% of all patients develop isolated tumor recurrences in regional lymph nodes. Three-year survival is significantly improved to more than 80% when biological effective doses of more than 100 Gy are applied to patients in good conditions. Systemic tumor recurrence still is a major problem, making an additional systemic chemotherapy interesting for selected patients after hSRT, such as those younger than 75 years.