Stereotactic body radiotherapy for early-stage non-small cell lung cancer: clinical outcomes from a National Patient Registry

Abstract

ObjectivesStereotactic body radiotherapy (SBRT) is a definitive local treatment option for patients with stage I non-small cell lung cancer (NSCLC) who are not surgical candidates and patients who refuse surgery. The purpose of this study was to assess the impact of SBRT on T1–T2 NSCLC from a national registry, reflecting practices and outcomes in a real-world setting.MethodsThe RSSearch® Patient Registry was screened for T1–T2N0M0 NSCLC patients treated from May 2004 to May 2013 with SBRT. Descriptive analyses were used for patient, tumor, and treatment characteristics. Overall survival (OS) and local control (LC) were calculated using the Kaplan-Meier method.ResultsIn total, 723 patients with 517 T1 and 224 T2 lesions were treated with SBRT. Median follow-up was 12 months (1–87 months) with a median age of 76 years. Median SBRT dose was 54 Gy (range 10–80 Gy) delivered in a median of 3 fractions (range 1–5), and median biological equivalent dose (BED10) was 151.2 Gy (range 20–240 Gy). Median OS was 30 and 26 months for T1 and T2 tumors, respectively (p = 0.019). LC was associated with higher BED10 for T2 tumors, but not in T1 tumors at a median follow-up of 17 months. Seventeen-month LC for T2 tumors treated with BED10 < 105 Gy, BED10 105-149, and BED10 ≥ 150 Gy was 43, 74, and 95 %, respectively (p = 0.011). Local failure rates for T2 tumors treated with BED10 < 105 Gy, 105–149 Gy, and ≥150 Gy were 32, 21, and 8 % (p = 0.029), respectively. Median OS for patients with T2 tumors treated with BED10 < 105 Gy was 17 vs. 32 months for T2 tumors treated with BED10 105–149 Gy (p = 0.062).ConclusionSBRT for T1–T2 NSCLC is feasible and effective in the community setting. OS was greater for patients with T1 lesions compared to T2 lesions. An improvement in LC was observed in patients with T2 lesions treated with BED10 > 105 Gy.

Guideline for Radiotherapy with Curative Intent in Patients with Early-Stage Medically Inoperable Non-Small-Cell Lung Cancer

“…However, the cut-off was difficult to determine. Several studies suggested that a bed cut-off of approximately 100 is significantly correlated with patient outcome 17,[19][20][21][22]26 ; however, other studies, including the meta-regression by Zhang et al, did not show that association 18,24,25,27,29 .…”

“…Twelve retrospective observational studies investigated the most appropriate bed cut-off in association with patient outcomes [17][18][19][20][21][22][23][24][25][26][27][28] . Again, the studies were considered to be very low quality because of their retrospective design.…”

“…Although variability in the results with the use of a bed cut-off of approximately 100 was evident, the largest studies suggested that a bed close to 100 was associated with os and local control 17,[19][20][21][22]26 . The dsg believed that recommending a minimal bed threshold would maximize the beneficial outcomes associated with sbrt without increasing harm.…”

“…The dsg believed that recommending a minimal bed threshold would maximize the beneficial outcomes associated with sbrt without increasing harm. They chose to use 100 as the bed threshold because most of the larger cohort studies found an association of patient outcomes with bed cut-offs of 100, 105, and 106 17,[19][20][21][22]26 . The dsg selected the lowest value because the Zhang meta-analysis found that, compared with lower values, medium values between 83.2 and 106 were associated with significantly better survival 29 .…”

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

“…[ [44][45][46] Additionally, in non-biased patients with stage IA NSCLC, mortality and severe morbidity seldom occurred, but controllable radiation pneumonitis developed in up to 20% of the patients, and the median 5-year survival rate was 39% (ranged, 30-73%).…”