Medically inoperable lung carcinoma: The role of radiation therapy

Dosoretz, Daniel E.; Katin, Michael J.; Blitzer, Peter H.; Rubenstein, James H.; Galmarini, D.; Garton, Graciela R.; Salenius, S.

doi:10.1016/s1053-4296(96)80006-3

Cited by 125 publications

(58 citation statements)

References 20 publications

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“…In medically inoperable patients, conventionally fractionated radiotherapy for early stage lung carcinoma has shown local control rates of only 30%-40% [3][4][5] . In the last decade stereotactic body radiotherapy (SBRT) has been described by many institutions and recently by the RTOG with local control rates comparable to lobectomy in medically inoperable patients [6][7][8][9][10][11] .…”

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confidence: 99%

Stereotactic body radiotherapy (SBRT) for non- pathologically diagnosed lung cancer patients

Harkenrider¹,

Bertke²,

Dragun³

2012

JST

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Objective: Medically inoperable patients with primary or recurrent lung cancer are increasingly being diagnosed clinically without pathologic confirmation especially for patients with comorbidities that preclude biopsy. The objective of this study is to report the outcomes of medically inoperable patients with unbiopsied primary or recurrent lung carcinoma with SBRT. From 2008From -2011 patients with non-pathologically diagnosed primary or recurrent lung cancer were treated with SBRT. All patients had diagnostic imaging clinically consistent with primary or recurrent lung malignancy. Fifteen patients had primary lung cancer and 7 had recurrent disease previously treated with surgery or fractionated radiotherapy. Median SBRT dose was 50 Gy (Range 40-55 Gy) in a median of 5 fractions (Range 4-10 fractions). Median BED was 100 Gy (Range 72-151.2 Gy). Methods:Results: Median follow up is 15.3 months (Range 6.6-33.0 months). Primary tumors had a median longest dimension on the original CT of 1.6cm, which enlarged to 2.0cm (P<0.001) on serial CT and decreased to 1.3cm (P=0.003) after SBRT. Recurrent tumors had a median longest dimension of 1.6cm, which increased to 2.7cm (P=0.33) on repeat CT and subsequently stabilized at 2.7cm after SBRT. On FDG-PET scan, median standard uptake value (SUV) for the entire population is 5.4 before SBRT which decreased to 2.3 (P<0.001) after treatment. For the entire population, absolute local control was 90.9%. Kaplan-Meier curves estimates at 2 years show regional control 100%, distant control 75%, cancer specific survival 92%, and overall survival 75%. There were no grade 3/4 acute or chronic treatment-related toxicities. Conclusions:In medically inoperable patients, a diagnosis of lung cancer can be provisionally made radiographically without pathologic confirmation. Local control can be achieved with minimal toxicity with the use of SBRT.

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confidence: 99%

Stereotactic body radiotherapy (SBRT) for non- pathologically diagnosed lung cancer patients

Harkenrider¹,

Bertke²,

Dragun³

2012

JST

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“…Patients with early-stage nsclc who are medically inoperable were previously offered conventional radiotherapy [rt (60-66 Gy in 1.8-2.0 Gy fractions)] or were observed without specific cancer treatment. The outcomes for such patients were not ideal, with 2-year survival being less than 40% with either conventional radiation or observation, and local control being only 40%-50% with conventional rt 3,4 .…”

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confidence: 99%

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

Falkson

Vella

et al. 2017

Current Oncology

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Objectives For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medically inoperable patients with early-stage non-small-cell lung cancer (nsclc). MethodsThe guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care and by the Lung Cancer Disease Site Group through a systematic review of mainly retrospective studies, expert consensus, and formal internal and external reviews. Recommendations■ Stereotactic body radiation therapy (sbrt) with curative intent is an option that should be considered for patients with early-stage, node-negative, medically inoperable nsclc. Qualifying Statements ■Because of the high dose per fraction, the planning process and treatment delivery for sbrt require the use of advanced technology to maintain an appropriate level of safety. Consistent patient positioning and 4-dimensional analysis of tumour and critical structure motion during simulation and treatment delivery are essential. ■Preliminary results for proton-beam therapy have been promising, but the technique requires further clinical study.■ Recommended fractionation schemes for sbrt should result in a biologically effective dose of 100 or greater by the linear quadric model, choosing an α/β value of 10 [bed 10(LQ) ≥ 100]. Qualifying Statements ■Because of the increased risk of treatment-related adverse events associated with centrally located tumours, consideration of tumour size and proximity to critical central structures is required when determining the dose and fractionation. ■Examples of dose-fractionation schemes used in the included studies have been provided. ■Based on the current evidence and the opinion of the authors, radiation doses at bed 10(LQ) greater than 146 might significantly increase toxicity and should be avoided. ■Determination of the radiation bed by the linear quadratic model has limitations for the extreme hypofractionated schemes used in sbrt.

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“…Alternative treatment options have traditionally included limited surgical resection or conventional radiotherapy. Unfortunately outcomes are generally inferior using either of those approaches [2][3][4] . For stage i nsclc, 5-year survival rates of 45%-59% and 0%-42% can generally be expected from limited surgical resection and conventional radiotherapy respectively 4 .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Accelerated Hypofractionated Radiotherapy in Stage i Non-Small-Cell Lung Cancer

et al. 2012

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Purpose: Outcomes after treatment with accelerated hypofractionated radiotherapy in stage i medically inoperable non-small-cell lung cancer (nsclc) patients were determined. Methods: Our single-institution retrospective review looked at medically inoperable patients with T1–2N0M0 nsclc treated with accelerated hypofractionated curative-intent radiotherapy between 1999 and 2009. Patients were staged mainly by computed tomography imaging of chest and abdomen, bone scan, and computed tomography/magnetic resonance imaging of brain. Positron-emission tomography (pet) staging was performed in 6 patients. Medical charts were reviewed to determine demographics, radiotherapy details, sites of failure, toxicity (as defined by the Common Terminology Criteria for Adverse Events, version 3.0) and vital status. The cumulative incidence of local and distant failure was calculated. Overall (os) and cause-specific (css) survival were estimated by the Kaplan–Meier method. Result: In the 60 patients treated during the study period, the dose regimens were 50 Gy in 20 fractions (n = 6), 55 Gy in 20 fractions (n = 8), 60 Gy in 20 fractions (n = 42), and 60 Gy in 25 fractions (n = 4). All patients were treated once daily. The median follow-up was 27 months (range: 4–94 months). The os rates at 2 and 5 years were 61% [95% confidence interval (ci): 50% to 75%] and 19% (95% ci: 10% to 34%) respectively. The css rates at 2 and 5 years were 79% (95% ci: 68% to 91%) and 39% (95% ci: 24% to 63%) respectively. The cumulative incidence of local failure was 20% at 5 years. The cumulative incidence of distant failure was 28% at 5 years. No patients experienced grade 3 or greater pneumonitis or esophagitis. Conclusions: Accelerated hypofractionated regimens are well tolerated and provide good local control in medically inoperable patients with stage i nsclc. Such regimens may be a reasonable treatment alternative when stereotactic body radiation therapy is not feasible.

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Medically inoperable lung carcinoma: The role of radiation therapy

Cited by 125 publications

References 20 publications

Stereotactic body radiotherapy (SBRT) for non- pathologically diagnosed lung cancer patients

Stereotactic body radiotherapy (SBRT) for non- pathologically diagnosed lung cancer patients

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

Outcomes of Accelerated Hypofractionated Radiotherapy in Stage i Non-Small-Cell Lung Cancer

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