Multi‐institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors

Verma, Vivek; Shostrom, Valerie; Kumar, Sameera; Zhen, Weining; Hallemeier, Christopher L.; Braunstein, Steve; Holland, John M.; Harkenrider, Matthew M.; Iskhanian, Adrian; Neboori, Hanmanth J.; Jabbour, Salma K.; Attia, Albert; Lee, Percy; Alite, Fiori; Walker, Joshua M.; Stahl, John M.; Wang, Kyle; Bingham, Brian; Hadzitheodorou, C.; Decker, Roy H.; McGarry, Ronald C.; Simone, Charles B.

doi:10.1002/cncr.30375

Cited by 84 publications

(47 citation statements)

References 27 publications

(50 reference statements)

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“…While there is mounting evidence on the outcomes of SBRT in < 5 cm primary lung tumors, 1-7 outcome on tumors > 5 cm remains underreported in the literature. 8,12 We aimed to improve the knowledge regarding this subset. Our results are similar to other series.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Large (> 5 cm) Non–Small-Cell Lung Cancer

Peterson

Niles

Patel

et al. 2017

Clinical Lung Cancer

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Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Large (> 5 cm) Non–Small-Cell Lung Cancer

Peterson

Niles

Patel

et al. 2017

Clinical Lung Cancer

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“…2,3 In recent years, stereotactic body RT (SBRT; also known as stereotactic ablative RT), has gained momentum for this purpose. [4][5][6] To date, multiple prospective trials have reported local control rates of at least 90% at 1 year and .80% at 3 years, with largely an absence of significant high-grade toxicities. [7][8][9][10] Furthermore, a pooled analysis from 2 prospective clinical trials reported that SBRT may produce equivalent or even superior outcomes compared with surgical resection for operable patients.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy Versus Nonradiotherapeutic Ablative Procedures (Laser/Cryoablation and Electrocautery) for Early-Stage Non–Small Cell Lung Cancer

Baine

Neilsen

Oupický

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Despite the fact that stereotactic body radiation therapy (SBRT) is the only recommended first-line therapy for inoperable early-stage non–small cell lung cancer (NSCLC), several thermal ablative procedures (TAPs; defined herein as laser/cryoablation and electrocautery) are available. Studies showing outcomes of these procedures and how they compare with SBRT are scarce. We sought to evaluate the comparative efficacy of SBRT versus TAPs using the National Cancer Database (NCDB). Methods: The NCDB was queried for patients with early-stage NSCLC who did not undergo surgical resection. Treatment-specific inclusion criteria were applied to select for patients receiving either TAPs or SBRT. Univariate logistic regression and Cox proportional hazards modeling were performed, and Kaplan-Meier curves were generated. Serial propensity matches were performed using a modified greedy 8→n matching 1:1 algorithm. Results: A total of 27,734 patients were analyzed; 26,725 underwent SBRT and 1,009 underwent TAPs. Patients who received SBRT were older and more likely to have clinical stage IB (vs IA) disease. Despite this, SBRT was associated with longer median overall survival (mOS; 37.7 vs 33.5 months; P=.001) and 1-, 2-, and 5-year OS rates compared with the TAPs cohort (86.7% vs 83.1%, 67.5% vs 62.7%, and 30.6% vs 26.9%, respectively; P=.001). Upon propensity matching, improved OS with SBRT remained, with a mOS of 40.4 versus 33.4 months and 1-, 2-, and 5-year OS rates of 89.0% versus 82.9%, 69.7% versus 62.7%, and 34.4% versus 26.4%, respectively (P=.003). Conclusions: Despite being associated with more higher-risk factors, SBRT was associated with higher OS compared with TAPs for treatment of nonoperative patients diagnosed with early-stage NSCLC. However, causation cannot be implied owing to the inherent limitations of large heterogeneous datasets such as the NCDB.

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“…For example, in 2013, Senthi et al reviewed publications between 2010 and 2012 that included a total of 418 patients treated with SBRT for centrally located tumors and found that grade 3 or greater toxicity was only seen in 8.6% of patients. Even in patients with large primary (≥ 5 cm) NSCLC, a multi-institutional series found no differences in grade 2 or greater toxicities based on central versus peripheral tumor location [13]. In our dataset specifically focused on patients who have either had a prior lung surgery and/or course of thoracic radiation therapy, we found that the rates of toxicity were low among patients with peripheral lesions, but a central location of the new treatment predisposed for a much higher risk, with a 6-month ≥ grade 2 toxicity rate of 36%.…”

Section: Discussionmentioning

confidence: 91%

Stereotactic body radiation therapy for non-small cell lung cancer patients with prior history of thoracic surgery and/or radiation therapy: the influence of smoking, size, and central location on risk of complications

et al. 2017

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Purpose The purpose of this retrospective cohort study was to evaluate the effect of tumor location and other major factors on the risk of complications from stereotactic body radiation therapy (SBRT) in non-small cell lung cancer (NSCLC) patients with a history of thoracic surgery and/or radiation therapy. Methods Medical records of patients with recurrent or second primary NSCLC treated with SBRT between 2005 and 2015 were reviewed. All patients had prior thoracic surgery and/or radiation therapy and were treated with image-guided, robotic SBRT. Time to local failure and toxicity was evaluated by using cumulative incidence and competing risk regression analysis. Overall survival was estimated using the Kaplan-Meier method. Results Fifty-six patients with 74 tumors treated with SBRT were included for analysis. Of the 74 tumors, 19 (26%) were centrally located within 2 cm of the proximal bronchial tree. At a median follow-up of 27 months (range = 5-129), the 2-year cumulative incidence of LF was 13% for peripheral tumors and 16% for central tumors (p = 0.95). Neither prior thoracic surgery nor radiation therapy was associated with increased LF or toxicity. Among the 56 patients, eight (14%), three (5%), and one (2%) experienced grade 2, 3, and 4 complications following SBRT. Patients with a ≥ 50 pack-year smoking history were more likely to develop ≥ grade 2 toxicity (HR 5.3; 95% CI 1.4-19.9, p = 0.01). Central tumor location was associated with higher risk of toxicity (HR 3.4; 95% CI 1.1-10.5, p = 0.04) as was planning tumor volume > 30 mL (HR 4.3; 95% CI 1.1-16.3, p = 0.047). In a multivariable model, central location remained significant after adjusting for smoking history and planning tumor volume. Conclusions After prior thoracic surgery and/or radiation, SBRT retreatment for NSCLC provided durable local control and was well tolerated in most patients. Patients with a history of previously operated and/or radiated lung cancer with new central tumors, PTV volume > 30 mL, or smoking history ≥ 50 pack-years were at higher risk of complications from SBRT.

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Multi‐institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors

Abstract: 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.

Cited by 84 publications

References 27 publications

Stereotactic Body Radiotherapy for Large (> 5 cm) Non–Small-Cell Lung Cancer

Stereotactic Body Radiotherapy for Large (> 5 cm) Non–Small-Cell Lung Cancer

Stereotactic Body Radiation Therapy Versus Nonradiotherapeutic Ablative Procedures (Laser/Cryoablation and Electrocautery) for Early-Stage Non–Small Cell Lung Cancer

Stereotactic body radiation therapy for non-small cell lung cancer patients with prior history of thoracic surgery and/or radiation therapy: the influence of smoking, size, and central location on risk of complications

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