Stereotactic Body Radiation Therapy in Early-Stage NSCLC: Historical Review, Contemporary Evidence and Future Implications

Abel, Stephen; Hasan, Shaakir; Horne, Zachary D.; Colonias, Athanasios; Wegner, Rodney E.

doi:10.2217/lmt-2018-0013

Cited by 18 publications

(18 citation statements)

References 65 publications

(91 reference statements)

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“…Likewise, this study found toxicity in the same proportions as previous reports: 31% clinically symptomatic RP [about 10-20% of patients in literature (range: 0-49% among published studies)] with most patients having asymptomatic Grade 1 pneumonitis (2,(15)(16)(17), 14% G1 chest wall pain [10-40% in literature (32)], 7% transient G ≤ 2 radiation dermatitis [12-38% in literature (33)], and 4% rib fractures [0-23% in literature (34)] without other toxicity. No significant predictive factor of chest wall pain, radiation dermatitis or rib fractures was found, probably due to meeting dose constraints (35).…”

Section: Discussionsupporting

confidence: 90%

“…When we started to treat patients in 2012, guidelines were less clear and CTV creation was debated (26). In our study, LC and OS were respectively over 95% and about 60% at the three-year point, which is consistent with previously published studies (1)(2)(3)25). No significant predictive factor of LC was found, probably because only three local failures were observed and adequate BED 10 was prescribed to the tumor.…”

Section: Discussionsupporting

confidence: 86%

“…Generally, overall survival (OS) for these patients in prospective studies is around 81-100, 65-70, 39-68, and 30-65%, respectively at 1, 2, 3 and 5 years. Local control (LC) is high, around 86-100 and 79-85%, respectively at 3 and 5 years (1)(2)(3). It is widely agreed that more NSCLC patients treated with SBRT die of comorbidities than of tumor progression.…”

Section: Introductionmentioning

confidence: 99%

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Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

et al. 2020

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Background: After stereotactic body radiation therapy (SBRT) for medically inoperable stage I non-small-cell lung cancer (NSCLC), more patients die of comorbidities, particularly severe pulmonary insufficiency, than of tumor progression. The aim of this study was to evaluate correlation between lung biologically effective dose (BED) with an α/β ratio of 3 Gy (BED 3) and overall survival (OS) for these patients. Methods: From 2012 to 2017, we have developed a prospectively updated institutional database for all first 100 consecutively treated patients with inoperable Stage 1 (T1T2N0M0) NSCLC. All SBRT were conducted on a Novalis Tx R LINAC with two coplanar dynamic conformal arcs (84%) or with coplanar volumetric modulated arc therapy (VMAT) (16%). Mean GTV and PTV were 8.6 cc and 50.8 cc, respectively. The marginal dose prescribed to the PTV was the 80% isodose line (IDL), i.e., 54 Gy in 3 fractions for 76 patients (BED 10 = 126 Gy) and 50 Gy in 5 fractions for 24 patients (BED 10 = 83.3 Gy). Pulmonary heterogeneity has been taken into account by using Monte Carlo or AAA algorithms. Median follow-up was 25 months. Results: At 1, 2, 3 and 5 years, local control (LC) was respectively 100, 98.2, 98.2, and 77.7%, and OS was respectively 83, 71.2, 58.1, and 33.2% (median OS was 49 months). Significant OS prognostic factors in univariate and multivariate analysis were mean lung BED 3 (HR = 1.14, p = 0.01) and PTV volume (HR = 1.01, p = 0.004). A mean lung BED 3 ≤ 5 Gy was significantly associated with a doubling of median OS from 29 months to more than 60 months (not achieved, p = 0.0068). For patients with a forced expiratory volume in 1 second (FEV1) ≤ 40%, a mean lung BED 3 ≤ 4 Gy was significantly associated with a doubling of median OS from 23 to 46 months (p = 0.019). Conclusion: Mean lung BED 3 is strongly and significantly associated with OS in SBRT for inoperable Stage I NSCLC. For all treated patients, a mean lung BED 3 ≤ 5 Gy lead to a doubling of median OS. This threshold value should be reduced to 4 Gy for patients with FEV1 ≤ 40%.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

et al. 2020

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“…Stereotactic body radiotherapy (SBRT) is widely accepted as the standard treatment for early stage nonsmall cell lung cancers (NSCLC) in patients who are not operative candidates [1][2][3]. The applications of thoracic SBRT has expanded over time and it is now increasingly used for the ablative treatment of metastatic lesions, particularly in the settings of oligometastatic and oligoprogressive disease [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors

Zhao

Khawandanh²,

Thomas³

et al. 2020

Radiat Oncol

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Background: For stereotactic body radiotherapy (SBRT) to central (C) and ultracentral (UC) lung tumors, our provincial practice has been to prioritize organs at risk (OARs) constraints by compromising target volume coverage if needed. The objectives are to report the treatment's efficacy and safety. Methods: We conducted a retrospective analysis of all provincial patients who underwent SBRT at 60Gy in 8 fractions to C and UC lung tumors, from 2013 to 2017. Results: Ninety-eight lesions were treated, 57 (58.2%) C and 41 (41.8%) UC. The median follow-up was 22.9 months (range 2.5-64.8 months). The 1-and 3-year local control (LC) was 97.8 and 84.5% respectively, with no differences between C and UC groups (p = 0.662). Fifty-three (54.1%) cases had optimal dose coverage (V60Gy ITV&PTV > 95%), 29 (29.6%) had compromised PTV coverage (V60Gy ITV > 95%/PTV < 95%), and 16 (16.3%) had both compromised ITV and PTV coverage (V60Gy ITV&PTV < 95%). No significant difference in LC was detected at 2 years between the 3 groups (95.6, 91.8 and 90.9%, p = 0.717). There were 3 episodes of grade 3 toxicity in the C group (2 dyspnea, 1 pneumonitis) and 2 in the UC group (1 dyspnea, 1 hemoptysis). There were no gr4/5 toxicities. On multivariable Cox regression analysis, ITV size was found to be a predictor for LC (p = 0.001). Conclusions: SBRT at 60Gy in 8 fractions achieves high rates of LC with low risks of significant toxicities, even if target volume coverage is reduced to meet OARs constraints.

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“…In the COMET study, the contribution of SBRT to oligometastatic disease in different primary tumors, including NSCLC, was examined, ablative dose administration especially for metastasis in NSCLC provided progression-free survival and survival advantage. [49,50]…”

Section: Post-operative Radiotherapy In Non-small Cell Lung Cancer (Pmentioning

confidence: 99%

Radiotherapy in Lung Cancer: Current and Future Role

2019

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L ung cancer is known to be the most commonly diagnosed cancer with high mortality and morbidity. Lung cancer is divided into two groups as non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These two groups should be seen as two different diseases concerning their clinical course. 80-85% of newly diagnosed lung cancer patients are NSCLC, and 15-20% is SCLC. According to Turkey cancer statistics in 2017, lung cancer is the first in cancer rate in men (52.5/100.000) and the fifth most common type of cancer in women (8.7/100000). 1-The Role of Radiotherapy in Non-Small Cell Lung Cancer Non-small cell lung cancer (NSCLC), which forms the majority of lung cancers, consists of squamous cell cancer, adenocarcinoma and large cell cancers. Although surgical resection is curative in the group without severe concomitant disease at the early-stage, radiosurgery has taken its place as the standard treatment approach in patients with comorbid disease. However, this group covers only 30% of the patients. [1, 2] Radiotherapy can be applied as definitive in the group with local and regional advanced disease with no surgical chance, as neoadjuvant in the group that has the potential to have surgery and can be applied as adjuvant considering some risk factors after surgery. Radiotherapy in metastatic disease is often used for palliative purposes, but radiosurgery may be an option for metastases in oligometastatic disease. 1A-Early Stage (I-II) Stereotactic Body Radiotherapy or Lung Radiosurgery Radiosurgery, which was introduced to our practice by Swedish brain surgeon Lars Leksell in 1950, was first used in the treatment of brain lesions. With the development Lung cancer is divided into two subgroups concerning its natural course and treatment strategies as follows: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In this review, for NSCLC, the role of stereotactic body radiation therapy (SBRT) in early-stage, chemoradiation in the locally advanced stage, post-operative radiotherapy for patients with high risk after surgery and radiotherapy for metastatic disease will be discussed. Also, for SCLC, the role and timing of thoracic irradiation and prophylactic cranial irradiation (PCI) for the limited and extensive stages will be discussed.

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Stereotactic Body Radiation Therapy in Early-Stage NSCLC: Historical Review, Contemporary Evidence and Future Implications

Cited by 18 publications

References 65 publications

Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT)

Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors

Radiotherapy in Lung Cancer: Current and Future Role

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