Radiation therapy in the management of medically inoperable carcinoma of the lungs: Results and implications for future treatment strategies

Dosoretz, Daniel E.; Katin, Michael J.; Blitzer, Peter H.; Rubenstein, James H.; Salenius, S.; Rashid, Mohammad H.; Dosani, Razak; Mestas, George; Siegel, Alan D.; Chadha, Tejvir T.; Chandrahasa, Thongadi; Hannan, Stephen E.; Bhat, Saligrama; Metke, Michael P.

doi:10.1016/0360-3016(92)91013-d

Cited by 227 publications

(84 citation statements)

References 14 publications

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“…Data for stereotactic body radiotherapy for early stage lung tumors have shown extremely impressive results, with 3-year local control rates 90%, 30,31 which is a dramatic improvement over historical local control rates of 30% to 50% using conventionally fractionated radiotherapy. 32,33 Multiple studies of liver stereotactic body radiotherapy have been reported showing local control rates ranging from 65% to 95% at 1 to 2 years. [5][6][7][8][9][10] Indeed, problems arise when comparing stereotactic body radiotherapy studies because of patient and treatment heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for colorectal liver metastases

Chang

Swaminath

Kozak

et al. 2011

Cancer

264

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BACKGROUND: This study was undertaken to determine outcomes of stereotactic body radiotherapy for colorectal liver metastases in a pooled patient cohort. METHODS: Patients with colorectal liver metastases from 3 institutions were included if they had 1 to 4 lesions, received 1 to 6 fractions of stereotactic body radiotherapy, and had radiologic imaging 3 months post-treatment. Sixty-five patients with 102 lesions treated from August 2003 to May 2009 were retrospectively analyzed. A tumor control probability (TCP) model was used to estimate the 3-fraction dose required for >90% local control after converting the schedule into biologically equivalent dose (BED), single-fraction equivalent dose, or linear quadratic model-based single-fraction dose. RESULTS: Forty-seven (72%) patients had 1 chemotherapy regimen before stereotactic body radiotherapy, and 27 (42%) patients had 2 regimens. The median followup was 1.2 years (range, 0.3-5.2 years). The median dose was 42 gray (Gy; range, 22-60 Gy). When evaluated separately by multivariate analysis, total dose (P ¼ .0015), dose/fraction (P ¼ .003), and BED (P ¼ .004) all correlated with local control by lesion. On multivariate analysis, nonactive extrahepatic disease was associated with overall survival (OS; P ¼ .046), and sustained local control was closely correlated (P ¼ .06). By using single-fraction equivalent dose, BED, or linear quadratic model-based single-fraction dose in the TCP model, the estimated dose range needed for 1-year local control >90% is 46 to 52 Gy in 3 fractions. CONCLUSIONS: Liver stereotactic body radiotherapy is well tolerated and effective for colorectal liver metastases. The strong correlation between local control and OS supports controlling hepatic disease even for heavily pretreated patients. For a 3-fraction regimen of stereotactic body radiotherapy, a prescription dose of 48 Gy should be considered, if normal tissue constraints allow. Cancer 2011;117:4060-

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for colorectal liver metastases

Chang

Swaminath

Kozak

et al. 2011

Cancer

264

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“…These studies showed that the majority of patients ultimately die of disseminated lung carcinoma rather than comorbid conditions, and that treatmentrelated complications are uncommon with doses of 60 to 65 Gy, even among elderly patients (37). Although some studies suggested better survival rates with increasing doses of radiation (10,14,20), others did not (7,11). Some studies showed that histologic type (22) and initial response to radiation (12) were associated with improved patient survival.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective analyses have reported the outcomes of patients treated with RT alone but did not include a control group (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). These studies showed that the prognosis of these patients is poor, with a 20% (range 13-39%) 5-year lung cancer-specific survival rate.…”

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confidence: 99%

Effectiveness of Radiation Therapy for Elderly Patients with Unresected Stage I and II Non–Small Cell Lung Cancer

Wisnivesky

Halm

Bonomi

et al. 2010

Am J Respir Crit Care Med

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Rationale: Radiotherapy (RT) is considered the standard treatment for patients with stage I or II non-small lung cancer who are not surgical candidates because of comorbities or preferences against surgery. Objectives: To compare the outcomes of patients treated with RT alone with those who were untreated to assess the effect of RT on survival. Methods: Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare files, we identified 6,065 unresected patients with histologically confirmed stage I and stage II non-small cell lung cancer, diagnosed between 1992 and 2002. We used propensity score methods and instrumental variable analysis to control for the possible effects of known as well as unmeasured confounders. Measurements and Main Results: Overall, 59% of patients received RT. The overall and lung cancer-specific survival of unresected patients treated with RT was significantly better compared with the untreated cases (P , 0.0001 for both comparisons). RT was associated with a 6-month improvement in median overall survival. Propensity score analyses showed that RT was associated with improved overall (hazard ratio, 0.74; 95% confidence interval, 0.70-0.78) and lung cancer-specific survival (hazard ratio, 0.73; 95% confidence interval, 0.69-0.78). Instrumental variable analysis also indicated improved outcomes among patients treated with RT. Conclusions: RT improves survival of elderly patients with unresected stage I or II lung cancer. These results should be confirmed in prospective trials.

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“…However, conventional RT has historically shown unsatisfactory results, with local relapse rates ranging from <50 to up to 70%, and with far inferior 5-year OS rates of 10-30% compared to surgical resection [9,10,11,12,13,14,15,16,17]. This is most likely because conventional RT doses ranging from 45 to 66 Gy at 1.8-2.0 Gy per fraction are probably too low to adequately provide enough cell kill to control these tumors.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Retrospective, Single-Center Study of 55 Patients

Bhandari

Stanford²,

Packianathan³

et al. 2016

Oncology

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Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) is an effective treatment for patients with early-stage non-small cell lung cancer (NSCLC) who are not surgical candidates or who refuse surgical management. In this study, we report on our clinical outcomes and toxicity in the treatment of early-stage NSCLC with SBRT. Methods and Materials: Fifty-five patients with 59 T1-2N0M0 NSCLC lesions were treated at our institution between December 2009 and August 2014. The majority of the patients [38 (69%)] were treated with 50 Gy in 5 fractions, 7 patients (13%) with 48 Gy in 4 fractions, 8 patients (14%) with 60 Gy in 3 fractions, 1 patient (2%) with 62.5 Gy in 10 fractions, and 1 patient (2%) with 54 Gy in 3 fractions. Tumor response was evaluated using RECIST 1.1, and toxicity was graded using the CTCAE (Common Terminology Criteria for Adverse Events) version 3.0. The primary endpoints of this retrospective review included rates of overall survival, disease-free and progression-free survival, local failure, regional failure, and distant failure. A secondary endpoint included radiation-related toxicities. Results: The median follow-up was 23.8 months (range 1.1-57.6). The 3-year local control, progression-free survival, and overall survival rates were 91, 55, and 71%, respectively. The median age at diagnosis was 67.9 years (range 51.4-87.1). There were a total of 54 T1N0 tumors (92%) and 5 T2N0 lesions (8%). Adenocarcinoma was the most common pathology, comprising 54% of the lesions. A total of 16 of the patients (29%) failed. Among these, 5 local (9%), 14 regional (25%), and 4 distant failures (7%) were observed. On follow-up, one patient had grade 2 and another had grade 5 pneumonitis. Three patients experienced grade 2 chest wall tenderness. Two patients had grade 1 rib fractures, one of which could not be discerned from radiation-induced toxicity versus a traumatic fall. Conclusion: The University of Mississippi Medical Center SBRT experience has shown that SBRT provides satisfactory local control and overall survival rates with minimal toxicity in early-stage NSCLC patients.

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Radiation therapy in the management of medically inoperable carcinoma of the lungs: Results and implications for future treatment strategies

Cited by 227 publications

References 14 publications

Stereotactic body radiotherapy for colorectal liver metastases

Stereotactic body radiotherapy for colorectal liver metastases

Effectiveness of Radiation Therapy for Elderly Patients with Unresected Stage I and II Non–Small Cell Lung Cancer

Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Retrospective, Single-Center Study of 55 Patients

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