Radical radiotherapy for medically inoperable non-small cell lung cancer in clinical stage I: a retrospective analysis of 149 patients

Morita, Kozo; Fuwa, Nobukazu; Suzuki, Yoshihiko; Nishio, Makoto; Sakai, Kunio; Tamaki, Yasuhiro; Niibe, Hideo; Chujo, Masao; Wada, Shigeru; Sugawara, Toshiyuki; Kita, Midori

doi:10.1016/s0167-8140(96)01828-2

Cited by 150 publications

(66 citation statements)

References 12 publications

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“…These SBRT results are an improvement over the historical controls of conventional fractionated radiotherapy with 17% to 55% OS at 3 years [7,8]. A meta-analysis by Grutters et al showed that the OS at 5 years for SBRT and conventional radiotherapy were 42.1% and 19.5%, respectively [4].…”

Section: Introductionmentioning

confidence: 92%

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702)

Onimaru

Shirato

Shibata

et al. 2015

Radiotherapy and Oncology

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Key Words: phase I study, continual reassessment method, non-small cell lung cancer (NSCLC), stereotactic body radiotherapy, SBRT. Short running title: Previous presentationThis work was presented at the 55th Annual Meeting of the American Society for Radiation Oncology, September 22 -25, 2013 in Atlanta, GA. / 28Abstract Purpose: To estimate the maximum tolerated dose (MTD) and to determine the recommended dose (RD) of stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinoma (NSCLC) with target volume (PTV) < 100 cc. Materials and Methods:The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the MTD. Dose limiting toxicity (DLT) was grade 3 radiation pneumonitis (RP) within 180 days after the start of SBRT, grade 2 RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D 95 of the PTV.Results: Fifteen patients were accrued. Only 1 experienced grade 2 RP at 60 Gy in 4fractions. It was difficult to fulfill the dose constraints at 60 Gy in 4 fractions, and the maximum dose level assigned by CRM was changed to 55 Gy in 4 fractions. The lower limit of 95% of the credible interval exceeded the adjacent level, and the RD was determined as 55 Gy in 4 fractions. Conclusions:The RD of SBRT for peripheral T2N0M0 NSCLC with PTV < 100 cc was determined to be 55 Gy in 4 fractions. / 28

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Section: Introductionmentioning

confidence: 92%

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702)

Onimaru

Shirato

Shibata

et al. 2015

Radiotherapy and Oncology

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“…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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“…The 3-year os rate for patients with small lung cancers who received conventionally fractionated rt at a median dose of 60-66 Gy has previously been reported to be only approximately 34% [4][5][6] , mainly because of primary disease progression in approximately 60% of patients. In contrast, because the rt fields included comprehensive lymph node regions in some patients, grades 3-5 toxicities occurred in approximately 2% of patients 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The 5-year os rate for small central-type lung cancers after conventional rt is only 15%-22% [4][5][6] . In addition, patients treated with conventional rt eventually develop local recurrence and distant metastasis, which lead to death, even if the initial disease is stage i.…”

Section: Introductionmentioning

confidence: 99%

Clinical Results of Accelerated Hypofractionated Radiotherapy for Central-Type Small Lung Tumours

et al. 2017

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PurposeWe evaluated the efficacy and toxicity of accelerated hypofractionated radiotherapy (ahypof-rt) for central-type small lung tumours. MethodsBetween November 2006 and January 2015, 40 patients with central-type small lung tumours underwent ahypof-rt delivered using 10 MV X-rays and a coplanar 3-field technique. The number of fractions ranged from 24 to 28, with a fraction size of 2.5-3 Gy. A total dose of 69-75 Gy to the isocentre of the planning target volume was administered to each patient. Cumulative survival and local control rates were calculated using the Kaplan-Meier method. ResultsThe 27 men and 13 women enrolled in the study had a median age of 79 years (range: 60−87 years). The tumour stage was T1a in 9 patients, T1b in 17 patients, and T2a in 14 patients, with a median size of 26.5 cm (range: 11-49 cm). The median follow-up period was 23 months. A complete response was achieved in 3 patients (7.5%), and a partial response, in 17 patients (42.5%). The overall 2-year and 3-year local control rates were 87.3% and 81.8% respectively; the 2-year and 3-year overall survival rates were 78.9% and 66.7% respectively. Grade 3 pneumonitis occurred in 3 patients; no other severe adverse events (≥grade 3) were observed in any patient.Conclusions Accelerated hypofractionated radiotherapy using a fraction size of 2.5-3 Gy was highly safe and can be a more effective treatment option than conventional radiotherapy for patients with central-type small lung tumours.

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Radical radiotherapy for medically inoperable non-small cell lung cancer in clinical stage I: a retrospective analysis of 149 patients

Cited by 150 publications

References 12 publications

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702)

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702)

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

Clinical Results of Accelerated Hypofractionated Radiotherapy for Central-Type Small Lung Tumours

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