Stereotactic Body Radiation Therapy for Early-Stage Non-Small-Cell Lung Carcinoma

Four-Year Results of a Prospective Phase II Study

Achilles J. Fakiris, Ronald C. McGarry, Constantin Yiannoutsos, Lech Papiez, Mark Williams, Mark A. Henderson, Robert Timmerman

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Abstract

Purpose: The 50-month results of a prospective Phase II trial of stereotactic body radiation therapy (SBRT) in medically inoperable patients are reported. Methods and Materials: A total of 70 medically inoperable patients had clinically staged T1 (34 patients) or T2 (36 patients) (≤7 cm), N0, M0, biopsy-confirmed non-small-cell lung carcinoma (NSCLC) and received SBRT as per our previously published reports. The SBRT treatment dose of 60-66 Gy was prescribed to the 80% isodose volume in three fractions. Results: Median follow-up was 50.2 months (range, 1.4-64.8 months). Kaplan-Meier local control at 3 years was 88.1%. Regional (nodal) and distant recurrence occurred in 6 (8.6%) and 9 (12.9%) patients, respectively. Median survival (MS) was 32.4 months and 3-year overall survival (OS) was 42.7% (95% confidence interval [95% CI], 31.1-54.3%). Cancer-specific survival at 3 years was 81.7% (95% CI, 70.0-93.4%). For patients with T1 tumors, MS was 38.7 months (95% CI, 25.3-50.2) and for T2 tumors MS was 24.5 months (95% CI, 18.5-37.4) (p = 0.194). Tumor volume (≤5 cc, 5-10 cc, 10-20 cc, >20 cc) did not significantly impact survival: MS was 36.9 months (95% CI, 18.1-42.9), 34.0 (95% CI, 16.9-57.1), 32.8 (95% CI, 21.3-57.8), and 21.4 months (95% CI, 17.8-41.6), respectively (p = 0.712). There was no significant survival difference between patients with peripheral vs. central tumors (MS 33.2 vs. 24.4 months, p = 0.697). Grade 3 to 5 toxicity occurred in 5 of 48 patients with peripheral lung tumors (10.4%) and in 6 of 22 patients (27.3%) with central tumors (Fisher's exact test, p = 0.088). Conclusion: Based on our study results, use of SBRT results in high rates of local control in medically inoperable patients with Stage I NSCLC.

Original languageEnglish
Pages (from-to)677-682
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume75
Issue number3
DOIs
StatePublished - Nov 1 2009

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Non-Small Cell Lung Carcinoma
lungs
radiation therapy
Radiotherapy
cancer
confidence
Confidence Intervals
intervals
Survival
tumors
Neoplasms
Tumor Burden
toxicity
grade
Biopsy
Recurrence
dosage
Lung

Keywords

  • Non-small-cell lung carcinoma
  • Radiation therapy
  • SBRT
  • Stage I
  • Stereotactic

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Stereotactic Body Radiation Therapy for Early-Stage Non-Small-Cell Lung Carcinoma : Four-Year Results of a Prospective Phase II Study. / Fakiris, Achilles J.; McGarry, Ronald C.; Yiannoutsos, Constantin; Papiez, Lech; Williams, Mark; Henderson, Mark A.; Timmerman, Robert.

In: International Journal of Radiation Oncology Biology Physics, Vol. 75, No. 3, 01.11.2009, p. 677-682.

Research output: Contribution to journalArticle

Fakiris, Achilles J. ; McGarry, Ronald C. ; Yiannoutsos, Constantin ; Papiez, Lech ; Williams, Mark ; Henderson, Mark A. ; Timmerman, Robert. / Stereotactic Body Radiation Therapy for Early-Stage Non-Small-Cell Lung Carcinoma : Four-Year Results of a Prospective Phase II Study. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 75, No. 3. pp. 677-682.
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abstract = "Purpose: The 50-month results of a prospective Phase II trial of stereotactic body radiation therapy (SBRT) in medically inoperable patients are reported. Methods and Materials: A total of 70 medically inoperable patients had clinically staged T1 (34 patients) or T2 (36 patients) (≤7 cm), N0, M0, biopsy-confirmed non-small-cell lung carcinoma (NSCLC) and received SBRT as per our previously published reports. The SBRT treatment dose of 60-66 Gy was prescribed to the 80{\%} isodose volume in three fractions. Results: Median follow-up was 50.2 months (range, 1.4-64.8 months). Kaplan-Meier local control at 3 years was 88.1{\%}. Regional (nodal) and distant recurrence occurred in 6 (8.6{\%}) and 9 (12.9{\%}) patients, respectively. Median survival (MS) was 32.4 months and 3-year overall survival (OS) was 42.7{\%} (95{\%} confidence interval [95{\%} CI], 31.1-54.3{\%}). Cancer-specific survival at 3 years was 81.7{\%} (95{\%} CI, 70.0-93.4{\%}). For patients with T1 tumors, MS was 38.7 months (95{\%} CI, 25.3-50.2) and for T2 tumors MS was 24.5 months (95{\%} CI, 18.5-37.4) (p = 0.194). Tumor volume (≤5 cc, 5-10 cc, 10-20 cc, >20 cc) did not significantly impact survival: MS was 36.9 months (95{\%} CI, 18.1-42.9), 34.0 (95{\%} CI, 16.9-57.1), 32.8 (95{\%} CI, 21.3-57.8), and 21.4 months (95{\%} CI, 17.8-41.6), respectively (p = 0.712). There was no significant survival difference between patients with peripheral vs. central tumors (MS 33.2 vs. 24.4 months, p = 0.697). Grade 3 to 5 toxicity occurred in 5 of 48 patients with peripheral lung tumors (10.4{\%}) and in 6 of 22 patients (27.3{\%}) with central tumors (Fisher's exact test, p = 0.088). Conclusion: Based on our study results, use of SBRT results in high rates of local control in medically inoperable patients with Stage I NSCLC.",
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