The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688-696. © 2016 American Cancer Society.

The treatment of gastric cancer requires a multimodal approach to decrease the risk of locoregional and distant recurrence. The optimal timing of chemotherapy, surgery, and radiation therapy continues to be explored in ongoing trials. In the United States, surgical resection is often followed by adjuvant chemoradiation therapy or by a combination of neoadjuvant and adjuvant chemotherapy. Here we report on 4 patients with resected gastric adenocarcinoma who were treated with a combination of these 2 approaches, receiving neoadjuvant chemotherapy followed by adjuvant chemoradiation therapy.

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Conclusion: A full range of dose-function metrics and functional thresholds were examined. The AUC values for the most predictive functional models occupied a narrow range (0.66-0.70) and all demonstrated improvements over AUC from traditional lung dose metrics (0.55). Identifying the dose-function parameters most predictive of grade 3+ RP provides valuable data for treatment planning and plan evaluation parameters. With prospective clinical trials of functional guided radiotherapy using 4DCT-ventilation imaging underway, this work provides seminal data to help establish guidelines for the implementation of functional guided radiotherapy.

The purpose of this study was to investigate the frequency of radiation pneumonitis and change of pulmonary function and their impact on survival after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of Japan Clinical Oncology Group (JCOG) study JCOG0403. Materials/Methods: Radiation pneumonitis was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0. The test of pulmonary function included forced expiratory volume in 1.0 second (FEV1.0) and oxygen saturation of peripheral artery (SpO2). These were measured before the start of SBRT and every 6 months after it. In a total of 169 pts (65 medically operable and 104 inoperable; median age,78) enrolled in the phase II study of SBRT with 48Gy in 4 fractions for T1N0M0 pathology-proven NSCLC (JCOG0403), 146 pts and 153 pts whose FEV1.0 and SpO2 were measured before the start of SBRT and at least once after the start of SBRT without events that might affect their pulmonary function, such as local recurrence, regional lymph node metastases, or lung metastases were included in the analysis of FEV1.0 and in the analysis of SpO2, respectively. The worst grade of radiation pneumonitis and the maximum change of pulmonary function were determined based on each record during the first 1 year after the start of SBRT. Hazard ratios (HR) and their 95% confidence intervals (CI) for overall survival (OS) between subgroups were estimated by the Cox proportional hazards model and the landmark analysis was applied to OS counted from 1 year and 30 days after the start of SBRT. Results: Radiation pneumonitis grade 2 or more was observed in 33 (20%) of 169 pts, 14 (22%) of 65 inoperable pts, and 19 (18%) of 104 operable pts. The pts with the factor of older age or tumor located in the middle or lower lobe had grade 2 or more radiation pneumonitis more frequently in the total of 169 pts (Fisher's exact test pZ0.033, pZ0.048). FEV1.0 was decreased by 10% or more in 46 (32%) in total, 18 (32%) of inoperable pts, and 28 (32%) of operable pts. Larger tumor size was associated with 10% or more decrease of FEV1.0 in the total pts (pZ0.010) and inoperable pts (pZ0.016). Absolute % of SpO2 decreased by 5% or more in 5 (3%) of the total of 153 pts, 2 (3%) of 59 inoperable pts, and 3 (3%) of 94 operable pts. Grade 2 or more radiation pneumonitis and 10% or more decrease of FEV1.0 were not associated with OS in any groups, but 5% or more absolute % of SpO2 decrease was a worse factor for OS in the total pts (HR Z 3.28: 95%CI, 1.31-8.20, log-rank test pZ0.007) and inoperable pts (3.63: 95%CI, 1.10-11.94, pZ0.023). Conclusion: The study suggested that more attention should be paid in the pts with the factor of older age, and tumor located in the middle or lower lobe for radiation pneumonitis, and the pts with larger tumor size for deteriorating pulmonary function. Decrease of absolute % of SpO2 5% or more might be a poor prognostic factor.