Abstract
BackgroundStereotactic body radiotherapy (SBRT) is evolving into a standard of care for unresectable lung nodules. Local control has been shown to be in excess of 90% at 3 years. However, some patients present with synchronous lung nodules in the ipsilateral or contralateral lobe or metasynchronous disease. In these cases, patients may receive multiple courses of lung SBRT or a single course for synchronous nodules. The toxicity of such treatment is currently unknown.MethodsBetween 2006 and 2012, 63 subjects with 128 metasynchronous and synchronous lung nodules were treated at the Mayo Clinic with SBRT. Demographic patient data and dosimetric data regarding SBRT treatments were collected. Acute toxicity (defined as toxicity < 90 days) and late toxicity (defined as toxicity > = 90 days) were reported and graded as per standardized CTCAE 4.0 criteria. Local control, progression free survival and overall survival were also described.ResultsThe median age of patients treated was 73 years. Sixty five percent were primary or recurrent lung cancers with the remainder metastatic lung nodules of varying histologies. Of 63 patients, 18 had prior high dose external beam radiation to the mediastinum or chest. Dose and fractionation varied but the most common prescriptions were 48 Gy/4 fractions, 54 Gy/3 fractions, and 50 Gy/5 fractions. Only 6 patients demonstrated local recurrence. With a median follow up of 12.6 months, median SBRT specific overall survival and progression free survival were 35.7 months and 10.7 months respectively. Fifty one percent (32/63 patients) experienced acute toxicity, predominantly grade 1 and 2 fatigue. One patient developed acute grade 3 radiation pneumonitis at 75 days. Forty six percent (29/63 patients) developed late effects. Most were grade 1 dyspnea. There was one patient with grade 5 pneumonitis.ConclusionMultiple courses of SBRT and SBRT delivery after external beam radiotherapy appear to be feasible and safe. Most toxicity was grade 1 and 2 but the risk was approximately 50% for both acute and late effects.
Highlights
Lung Stereotactic body radiotherapy (SBRT) has classically been used to treat solitary lung lesions in early stage non-small cell lung cancer in patients who are not candidates for primary curative resection [1,2]
Within the last 3 years, SBRT has been adopted for the treatment of oligometastatic disease in the lung from varying histologies with 2 year local
The low toxicity reported for lung SBRT has led to its increased use in the oligometastatic and recurrent lung cancer setting [5,6]
Summary
Lung SBRT has classically been used to treat solitary lung lesions in early stage non-small cell lung cancer in patients who are not candidates for primary curative resection [1,2]. Most patients received two courses of SBRT, one to a target in each lung, over the course of 2 months. A recent series of 15 patients (76 SBRT treated lesions among them) suggested that those with synchronous disease did poorly while those with metasynchronous multiple pulmonary nodules had good 2 year overall survival (68%) [8]. Some patients present with synchronous lung nodules in the ipsilateral or contralateral lobe or metasynchronous disease. In these cases, patients may receive multiple courses of lung SBRT or a single course for synchronous nodules. Patients may receive multiple courses of lung SBRT or a single course for synchronous nodules The toxicity of such treatment is currently unknown
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