Stereotactic Body Radiation Therapy Outcomes for Early Stage and Oligometastatic Non–Small Cell Lung Cancer Based on Molecular Profile

Abstract

survival (OS). Recursive partitioning analysis (RPA) was done to determine a cutoff point of KPS for improved CSS and OS. Results: Fifty-eight patients met study criteria with median age of 84.9 years, median KPS of 70, median dose per fraction of 10 Gy, and median number of fractions of 5. Twenty-three (39.7%) were adenocarcinomas, 17 (29.3%) squamous cell carcinomas, and 18 (31.0%) not biopsied. Three-year rates of LR, RR, RP, CSS, and OS were 39.5%, 43.9%, 34.5%, 83.2%, and 69.2% respectively. On MVA, adenocarcinoma histology (HRZ6.36; PZ.01) was associated with higher LR, while T1 tumors had lower LR (HRZ0.20; P<.01). On MVA, higher KPS was associated with lower LR (HRZ0.92; P<.01) and RR (HRZ0.94; P<.01). On MVA, older age (HRZ1.19; PZ.04) and prior lung cancer (HRZ7.75; PZ.01) were associated with lower CSS, while not actively smoking (HRZ0.14; PZ.03) was associated with higher CSS. On MVA, only higher KPS (HRZ0.91; P<.01) was associated with higher OS. On MVA, not being on an ACE-I (HRZ3.49; PZ.02) was associated with higher rates of RP. On RPA, KPS of 75 was the breakpoint for improved CSS and OS. Conclusion: In this multi-center review of patients 80 years old treated with definitive lung SBRT, treatment was well tolerated with excellent 5-year CSS estimated rates. Patients 80 years old with KPS of 70 are effectively managed with SBRT. The association between ACE-I usage and lower rates of RP is hypothesis generating.

Which patients benefit most from stereotactic body radiotherapy or surgery in medically operable non‐small cell lung cancer? An in‐depth look at patient characteristics on both sides of the debate

“…For example, in an analysis by Blumenfeld et al ., there was a trend towards improved PFS for EGFR mutation positive patients after SBRT, 25.4 months versus 16.7 months, and KRAS negative patients (17.8 months vs. 9.5 months). There appeared to be no difference in toxicity between patients with or without these mutations . Such studies could potentially identify a population of patients with better outcomes from SBRT.…”