Abstract
BackgroundStereotactic ablative radiotherapy (SABR) can achieve excellent local control rates in early-stage non-small cell lung cancer (NSCLC) and has emerged as a standard treatment option for patients who cannot undergo surgery or those with isolated recurrences. However, factors that may predict toxicity or survival are largely unknown. We sought here to identify predictors of survival and pneumonitis after SABR for NSCLC in a relatively large single-institution series.MethodsSubjects were 130 patients with stage I NSCLC treated with four-dimensional computed tomography (4D CT) –planned, on-board volumetric image–guided SABR to 50 Gy in 4 fractions. Disease was staged by positron emission tomography/computed tomography (PET/CT) and scans were obtained again at the second follow-up after SABR.ResultsAt a median follow-up time of 26 months, the 2-year local control rate was 98.5%. The median overall survival (OS) time was 60 months, and OS rates were 93.0% at 1 year, 78.2% at 2 years, and 65.3% at 3 years. No patient experienced grade 4–5 toxicity; 15 had radiation pneumonitis (12 [9.3%] grade 2 and 3 [2.3%] grade 3). Performance status, standardized uptake value (SUV)max on staging PET/CT, tumor histology, and disease operability were associated with OS on univariate analysis, but only staging SUVmax was independently predictive on multivariate analysis (P = 0.034). Dosimetric factors were associated with radiation pneumonitis on univariate analysis, but only mean ipsilateral lung dose ≥9.14 Gy was significant on multivariate analysis (P = 0.005).ConclusionsOS and radiation pneumonitis after SABR for stage I NSCLC can be predicted by staging PET SUVmax and ipsilateral mean lung dose, respectively.
Highlights
Stereotactic ablative radiotherapy (SABR) can achieve excellent local control rates in early-stage nonsmall cell lung cancer (NSCLC) and has emerged as a standard treatment option for patients who cannot undergo surgery or those with isolated recurrences
Stereotactic ablative radiotherapy (SABR), known as stereotactic body radiotherapy (SBRT), can achieve local control rates exceeding 90% as well as promising survival rates in such cases when a biologically effective dose (BED) of more than 100 Gy is delivered to the planning target volume (PTV) [3,4,5,6,7,8,9,10,11]
SABR has emerged as a standard treatment option for stage I disease in patients who cannot undergo surgery for medical reasons [3,4,5,6,7] and for isolated recurrences of NSCLC [6,12,13]
Summary
Stereotactic ablative radiotherapy (SABR) can achieve excellent local control rates in early-stage nonsmall cell lung cancer (NSCLC) and has emerged as a standard treatment option for patients who cannot undergo surgery or those with isolated recurrences. SABR has emerged as a standard treatment option for stage I disease in patients who cannot undergo surgery for medical reasons [3,4,5,6,7] and for isolated recurrences of NSCLC [6,12,13]. We reported clinical outcome and used long-term follow-up data to identify potentially predictive factors for survival and pneumonitis among 130 patients with stage I NSCLC treated with SABR to 50 Gy delivered in 4 fractions over 4 consecutive days (BED 112.5 Gy) The information about factors that may predict survival and pneunonitis after SABR is limited because of the heterogeneity of the patients and dose regimens [13,14,15,16,17,18,19].
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