Abstract
IntroductionLung stereotactic body radiation therapy (SBRT) is a first-line treatment for early-stage lung cancer in non-surgical candidates or those who refuse surgery. We compared our institutional outcomes from a unique patient population with decreased barriers to care with a recently published prospective series.Materials and methods We retrospectively reviewed all patients who received definitive lung SBRT at the Walter Reed National Military Medical Center from 2015 to 2020. All patients underwent a positron emission tomography-computed tomography (PET-CT) and all were presented at a multidisciplinary tumor board. Patients were treated on a Trubeam linear accelerator (LINAC)-based system with daily cone-beam CT. The results were qualitatively compared to outcomes from prospective studies including RTOG 0236 and RTOG 0618.ResultsA total of 105 patients with 114 lesions were included. Median age was 77 years and 54.7% had ≥ 40-pack year smoking history. 36.8% did not have pathologic confirmation. With a median follow-up of 24 months, three-year local control (LC), disease-free survival (DFS) and overall survival (OS) rates were 92.4%, 81.0%, and 80.0%, respectively. Rates of Grade 1 and 2 toxicity were 21.9% and 6.7% and no patients experienced Grade ≥ 3 toxicity.ConclusionsIn our military setting with universal coverage and routine multidisciplinary care, lung SBRT provides outcomes comparable to prospective studies conducted at high-volume academic centers. More than one-third of patients were treated empirically without pathologic confirmation of disease, demonstrating a difference between clinical trials and community practice. Further investigation is warranted to integrate multidisciplinary management and achieve equal access to care to bridge existing health disparities in the community setting.
Highlights
Lung stereotactic body radiation therapy (SBRT) is a first-line treatment for early-stage lung cancer in nonsurgical candidates or those who refuse surgery
In our military setting with universal coverage and routine multidisciplinary care, lung SBRT provides outcomes comparable to prospective studies conducted at high-volume academic centers
SBRT is recommended as a standard therapy for early-stage non-small cell lung cancer (NSCLC) who are not surgical candidates or for patients who refuse surgery
Summary
We retrospectively reviewed all patients who received definitive lung SBRT at the Walter Reed National Military Medical Center from 2015 to 2020. We retrospectively reviewed all patients who were treated with definitive lung SBRT for early-stage NSCLC at our institution (Walter Reed National Military Medical Center; WRNMMC) from January 2015 to August 2020 after obtaining Institutional Review Board (IRB) approval. All patients were presented at multidisciplinary tumor board including Cardiothoracic Surgery, General & Interventional Pulmonology, Medical Oncology, Radiology, Pathology, and Radiation Oncology. This tumor board met weekly and reviewed patients at initial diagnosis and following any changes to their clinical status. An initial gross target volume (GTV) was contoured and expanded to an internal target volume (ITV) for motion management This was expanded 5 millimeters to a planning target volume (PTV)
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