Stereotactic Body Radiation Therapy for Early-Stage Non–Small-Cell Lung Cancer: The Pattern of Failure Is Distant

• Published in: International journal of radiation oncology, biology, physics Vol. 77; no. 4; pp. 1146 - 1150
• Main Authors: Bradley, Jeffrey D., M.D, El Naqa, Issam, Ph.D, Drzymala, Robert E., Ph.D, Trovo, Marco, M.D, Jones, Griffin, Denning, Mary Dee, R.N
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.07.2010; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; BODY; Bronchus; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; DISEASES; Dose Fractionation; DOSES; FAILURES; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; LUNGS; Male; Medical sciences; MEDICINE; METASTASES; Middle Aged; Neoplasm Staging - methods; NEOPLASMS; Neoplasms, Second Primary - etiology; NUCLEAR MEDICINE; ORGANS; Pneumology; Proportional Hazards Models; Radiation dose; RADIATION DOSES; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - adverse effects; Radiosurgery - methods; RADIOTHERAPY; RESPIRATORY SYSTEM; SBRT; Stereotactic radiation therapy; THERAPY; Treatment Failure; Tumor Burden; Tumors of the respiratory system and mediastinum; Radiation dose; Lung cancer; Stereotactic radiation therapy; SBRT; Lung disease; Respiratory disease; Early stage; Stereotaxia; Malignant tumor; non-small cell lung carcinoma; Radiotherapy; Treatment; Bronchus disease; Failure; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.06.017

Background Stereotactic body radiation therapy (SBRT) represents a substantial paradigm shift in the treatment of patients with medically inoperable Stage I/II non–small-cell lung cancer. We reviewed our experience using either three- or five-fraction SBRT for peripheral or central tumors, respectively. Methods and Materials A total of 91 patients signed an institutional review board–approved consent form, were treated with SBRT, and have had ≥6 months of follow-up. Patients were referred for SBRT because of underlying comorbidities (poor performance status in 31 or poor lung function in 52) or refusal of surgery (8 patients). Of the cancers, 83 were peripheral and eight were central. Peripheral cancers received a mean dose of 18 Gy × three fractions. Cancers within 2 cm of the bronchus, esophagus, or brachial plexus were treated with 9 Gy × five fractions. Results The median follow-up duration for these patients was 18 months (range, 6–42 months). TNM staging was as follows: 58 patients with T1N0M0, 22 with T2N0M0, 2 with T3N0M0 (chest wall), and 6 with T1N0M1 cancers. The median tumor diameter was 2 cm (range, 1–5 cm). The median forced expiratory volume in 1 s was 46% (range, 17–133%) and the median carbon monoxide diffusing capacity (DLCO) was 49% (range, 15–144%). Two-year local tumor control was achieved in 86% of patients. The predominant pattern of failure was the development of distant metastasis or second lung cancer. The development of distant metastasis was the only significant prognostic factor for overall survival on multivariate analysis. Conclusions Local tumor control was shown to be high using SBRT for non–small-cell lung cancer. Overall survival is highly coerrelated with the development of distant metastasis.