Outcomes Of Stereotactic Body Radiotherapy Research Articles

P3.16-13 Long-Term Outcomes of Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer in Patients Less Than 70 Years of Age

We retrospectively analyzed the treatment outcome of stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer (NSCLC) in patients less than 70 years of age. We retrospectively analyzed patients with stage I (cT1-2aN0M0) NSCLC, treated with SBRT between 2000 and 2014. 43 consecutively treated patients less than 70 years of age were identified. Staging was reassessed by UICC 7th. Both biopsy-proven and clinically diagnosed stage I NSCLC were included. Overall survival (OS), cause-specific survival (CSS), local control rate (LCR), regional lymph node control rate (RLNCR), and distant control rate (DCR) were calculated and compared between subsets of patients. Kaplan-Meier estimates were utilized for survival analyses, and evaluated by the log-rank test. Common Terminology Criteria for Adverse Events (CTCAE) v4.0 scales were recorded during follow-ups and utilized for toxicity assessments. For the 43 patients included, median age was 65 years (Range: 50-69 years), median Karnofsky performance status was 100 (Range: 80-100), and median follow-up time was 58 months (Range: 7-193 months). Median prescription dose was 48 Gy in 4 fractions (Range: 48-70Gy in 4-10 fractions). The rates for OS and CSS at 5 years were 63.8% and 91.5%, respectively. The 5-year LCR, RLNCR, and DCR were 92.4%, 91.7%, 78.7%, respectively. In the subsets analysis, patients were subcategorized into Group Ia and Group Ib, according to the T-stage, or subcategorized into Operable group and Inoperable group. Although there was no significant between the groups, Group Ia, and Operable group showed a better result in OS, but not in others. Regarding treatment toxicity, severe (grade 3 or above) radiation pneumonitis occurred in 6.8% of the cases, and no other toxicities of Grade 2 or above were observed. SBRT for stage I NSCLC in patients less than 70 years of age yielded good long-term survival outcomes with acceptable toxicity.

Stereotactic Body Radiation Therapy for Patients with Pulmonary Interstitial Change: High Incidence of Fatal Radiation Pneumonitis in a Retrospective Multi-Institutional Study.

Pretreatment pulmonary interstitial change (PIC) has been indicated as a risk factor of severe radiation pneumonitis (RP) following stereotactic body radiation therapy (SBRT) for early-stage lung cancer, but details of its true effect remain unclear. This study aims to evaluate treatment outcomes of SBRT for stage I non-small cell lung cancer in patients with PIC. A total of 242 patients are included in this study (88% male). The median age is 77 years (range, 55–92 years). A total dose of 40–70 Gy is administered in 4 to 10 fractions during a 4-to-25 day period. One, two, and three-year overall survival (OS) rates are 82.1%, 57.1%, and 42.6%, respectively. Fatal RP is identified in 6.9% of all patients. The percent vital capacity <70%, mean percentage normal lung volume receiving more than 20 Gy (>10%), performance status of 2–4, presence of squamous cell carcinoma, clinical T2 stage, regular use of steroid before SBRT, and percentage predicting forced expiratory volume in one second (<70%) are associated with worse prognoses for OS. Our results indicate that fatal RP frequently occurs after SBRT for stage I lung cancer in patients with PIC.

Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC)

Background: Stereotactic body radiotherapy (SBRT) has been adopted as the standard of care for inoperable early-stage non-small cell lung cancer (NSCLC), with local control rates consistently >90%. However, data directly comparing the outcomes of SBRT with those of conventionally fractionated radiotherapy (CONV) is lacking.Material and methods: Between 1990 and 2013, 497 patients (525 lesions) with early-stage NSCLC (T1-T2N0M0) were treated with CONV (n = 127) or SBRT (n = 398). In this retrospective analysis, five endpoints were compared, with and without adjusting for clinical and dosimetric factors. Competing risks analysis was performed to estimate and compare the cumulative incidence of local failure (LF), nodal failure (NF), distant failure (DF) and disease progression. Overall survival (OS) was estimated by the Kaplan–Meier method and compared by the Cox regression model. Propensity score (PS) matched analysis was performed based on seven patient and clinical variables: age, gender, Karnofsky performance status (KPS), histology, T stage, biologically equivalent dose (BED), and history of smoking.Results: The median dose delivered for CONV was 75.6 Gy in 1.8–2.0 Gy fractions (range 60–90 Gy; median BED = 89.20 Gy) and for SBRT 48 Gy in four fractions (45–60 Gy in three to five fractions; median BED = 105.60 Gy). Median follow-up was 24.4 months, and 3-year LF rates were 34.1% with CONV and 13.6% with SBRT (p < .001). Three-year OS rates were 38.9 and 53.1%, respectively (p = .018). PS matching showed a significant improvement of OS (p = .0497) for SBRT. T stage was the only variable correlating with all five endpoints.Conclusion: SBRT compared to CONV is associated with improved LF rates and OS. Our data supports the continued use and expansion of SBRT as the standard of care treatment for inoperable early-stage NSCLC.

Stereotactic body radiotherapy to treat small lung lesions clinically diagnosed as primary lung cancer by radiological examination: A prospective observational study

ObjectivesEven with advanced image guidance, biopsies occasionally fail to diagnose small lung lesions, which are highly suggestive of primary lung cancer by radiological examination. The aim of this study was to evaluate the outcome of stereotactic body radiotherapy (SBRT) to treat small lung lesions clinically diagnosed as primary lung cancer. Materials and methodsThis is a prospective, multi-institutional observation study. Strict inclusion and exclusion criteria were determined in a nation-wide consensus meeting and used to include patients who were clinically diagnosed with primary lung cancer using precise imaging modalities, for whom further surgical intervention was not feasible, who refused watchful waiting, and who were highly tolerable of SBRT with informed consent. SBRT was performed with 48 Gy in 4 fractions at the tumor isocenter. ResultsFrom August 2009 to August 2014, 62 patients from 11 institutions were enrolled. Their median age was 80 years. The tumors ranged in size from 9 to 30 mm in diameter (median, 18 mm). The median follow-up interval was 55 months. The 3-year overall survival rate was 83.3% (95% confidence interval (CI) 71.1–90.7%) for all the patients and 94.7% (95% CI 68.1–99.2%) for the patients younger than 75 years. Local failure, regional lymph node metastases and distant metastases occurred in 4 (6.4%), 3 (4.8%) and 11 (17.7%) patients, respectively. Grades 3 and 4 toxicities were observed in 8 (12.9%) patients and 1 (1.6%) patient, respectively. No grade 5 toxicities were observed. ConclusionsSBRT is safe and effective for patients with small lung lesions clinically diagnosed as primary lung cancer that satisfied the proposed strict indication criteria as previously reported. A prospective interventional study is required to ascertain if SBRT is an alternative strategy for these patients.

207P A comparison of outcomes of stereotactic body radiotherapy versus metastasectomy in patients with pulmonary metastases

207P A comparison of outcomes of stereotactic body radiotherapy versus metastasectomy in patients with pulmonary metastases

Long-term outcome of stereotactic body radiotherapy for patients with small hepatocellular carcinoma.

To evaluate the long-term outcome of stereotactic body radiotherapy in patients with small hepatocellular carcinoma who were ineligible for resection or ablation therapies. A total of 65 patients with 74 hepatocellular carcinomas (median tumor size 16mm) were enrolled in the present study. They were treated with the prescribed dose of 48Gy in four fractions at the isocenter. We extended the observation period and analyzed long-term outcomes, including overall survival, progression-free survival, local control, and various prognostic factors, in these patients. The median follow-up period was 41months for all patients and 62months for surviving patients. The 3- and 5-year overall survival rates were 56.3% (95% confidence interval, 44.1-68.5%) and 41.4% (95% confidence interval, 28.7-54.1%), respectively. The 3- and 5-year progression-free survival rates were 25.4% (95% confidence interval, 14.0-36.8%) and 10.6% (95% confidence interval, 1.5-19.8%), respectively. The 3- and 5-year local control rates were both 100% (95% confidence interval 100%). Liver toxicities exceeding grade3 were observed in 15 patients (23.1%). The proportion of patients who had grade ≥3 toxicities did not increase. Adverse effects (grade ≤2) presented as significant prognostic factors of overall survival, while TNM stage (T1N0M0) was a significant prognostic factor of progression-free survival after multivariate analysis. Stereotactic body radiotherapy was effective for patients with small hepatocellular carcinomas who were ineligible for resection or ablation therapies. The incidence of grade ≥3 adverse effects did not increase, even after longer follow-up times.

Long-term outcomes of stereotactic body radiotherapy for low- and intermediate-risk prostate adenocarcinoma: A multi-institutional consortium study.

84 Background: While a growing body of evidence supports the use of stereotactic body radiotherapy (SBRT) for the treatment of low- and intermediate-risk prostate adenocarcinoma (PCa), some trepidation exists regarding its long-term efficacy and safety. Methods: Men with low- and intermediate-risk PCa, as defined per the National Comprehensive Cancer Network guidelines, who were enrolled on various institutional phase II trials of SBRT between 2000-2012 were included in a multi-institutional consortium. Biochemical relapse (BCR) was defined as PSA &gt; “nadir +2” or initiation of androgen deprivation therapy (ADT). Toxicity data were scored according to the CTCAE v 3.0 or Radiation Therapy Oncology Group scoring systems. Results: A total of 1644 men were eligible for analysis, with a median followup of 7.2 years. 297 patients (18.1%) had at least 9 years of followup. Fractionation schemes ranged from 33.50-40 Gy in 4-5 fractions. 892 patients had low-risk disease and 752 had intermediate-risk disease. 59 patients (3.6%) received short-term ADT. 100 patients (6.0%) experienced BCR, and 7 (0.4%) experienced distant metastases. No patients died of PCa. By Kaplan-Meier analysis, 5- and 10-year BCR-free survival rates were 98% and 94% in the low-risk group and 96% and 90% in the intermediate-risk group (p &lt; 0.05 by log-rank test). 5- and 10-year overall survival rates were 93% and 86% in the low-risk group and 95% and 91% in the intermediate-risk group (p &gt; 0.05 by log-rank test). Five patients (0.3%) experienced grade 3 acute genitourinary (GU) toxicities, including urinary retention, hematuria, and frequency. 30 (2%) experienced grade 3 late GU toxicity, including urinary strictures, hematuria, and retention. One late grade 4 GU toxicity (hemorrhagic urethritis) and one late grade 4 gastrointestinal toxicity (fistula-in-ano) were seen. Conclusions: To the best of our knowledge, this is the largest analysis of long-term outcomes following SBRT for PCa. The results indicate that SBRT has an efficacy and toxicity profile that compares favorably to more widespread forms of treatment, such as conventionally-fractionated external beam radiotherapy and brachytherapy.

Clinical outcome of stereotactic body radiotherapy for abdominal lymph node metastases.

Aims and background. To report the clinical outcome of linac-based or robotic, image-guided stereotactic body radiotherapy in patients affected by abdominal lymph node metastases from different primary cancers. Methods and methods. Twenty-six patients with 32 abdominal lymph node metastases were consecutively treated at the University of Florence between April 2011 and May 2012. The mean follow-up was 4.6 months (SD, 3.9; range, 0.3-13). The dose prescription ranged between 24 Gy and 36 Gy delivered in 1-5 fractions. Results. In terms of local control, complete response to stereotactic body radiotherapy was obtained in 18 cases (66.7%), partial response in 7 (25.9%), and stable disease in 2 (7.4%). At the Cox univariate regression analysis, an increased risk of partial response or absence of local response to radiotherapy was found for subjects of the female sex (P = 0.036), age less than 50 years (P = 0.022), primary tumor of the genital tract (P = 0.007), and previous chemotherapy (P = 0.057). An excellent local control rate (90.9%) was obtained in patients affected by abdominal lymph node metastases of prostatic origin. Conclusions. Stereotactic body radiotherapy for abdominal lymph node metastases is a safe and effective treatment in terms of high rates of local control, especially in a subset of patients affected by prostate cancer.

Stereotactic Body Radiotherapy Treatment for Recurrent, Previously Irradiated Head and Neck Cancer

Purpose:Locally recurrent, previously irradiated primary head and neck tumors have historically been associated with poor outcomes. Stereotactic body radiation therapy has emerged as a feasible and promising treatment option for tumor recurrence, particularly in nonsurgical candidates. This study aimed to assess the associated outcomes of stereotactic body radiation therapy used in this setting.Methods:Retrospective analysis of a prospectively collected database of 25 patients treated with CyberKnife for unresectable, recurrent head and neck cancer in a previously irradiated field. The primary end points evaluated were rates of survival, tumor control, and treatment-related toxicities.Results:Median survival of the study population was 7.5 months (range, 1.5-47.0 months). Median survival of the 20 (80%) patients who were treated with curative purpose was 8.3 months. One-year overall survival rate for the entire population was 32%. The respective 1-year and 2-year survival rates for the curative subcohort were 40% and 20%, respectively. Local and locoregional failure occurred in 8 (32%) and 7 (28%) patients, respectively. Low severe acute (4%) and late (6%) treatment-related toxicity rates were observed. No grade 4 or 5 toxicities were observed.Conclusion:Stereotactic body radiation therapy is a viable treatment option for patients with unresectable, recurrent head and neck cancer. Significant tumor control rates are achievable with minimal severe toxicity. Although perhaps associated with patient selection and a heterogeneous sample, overall survival of stereotactic body radiation therapy outcomes appears unfavorable.

Stereotactic Body Radiotherapy for Spinal Metastases: Clinical Experience in 134 Cases From a Single Japanese Institution.

Object:This study aimed to clarify the outcomes of stereotactic body radiotherapy for spinal metastases with a uniform dose fractionation schedule in our institution.Materials and Methods:Patients treated with spine stereotactic body radiotherapy were retrospectively reviewed. The prescribed dose was 24 Gy in 2 fractions. End points were local control, pain control, and adverse events. Local control was defined as elimination, shrinkage, or stable disease in the tumor on imaging evaluations. Pain status was measured on a scale of 0 to 10 by patients’ self-reports, and pain response was defined as the time at which pain scale score decreased by 2 or more from the baseline score without increase in analgesics. In addition, various treatment- and tumor-specific factors were evaluated to determine predictive values for local and pain control.Results:This study included 134 lesions in 131 patients, with: lesion histopathology, lung/colorectal/thyroid/renal/breast/prostate/sarcoma/other cancer, 24/22/18/14/12/10/6/25; reirradiation stereotactic body radiotherapy, 82 (61.2%) cases; and postoperative stereotactic body radiotherapy for epidural spinal cord compression, 45 (33.6%) cases. Median follow-up after stereotactic body radiotherapy was 9 months. The 1-year local control rate was 72.3%. Seventy (79.5%) of the 88 cases with pain from spinal metastases achieved pain response. The 1-year pain progression-free rate was 61.7%. Regarding metastases from colorectal cancer, local and pain control rates at 1 year were significantly lower compared with other cancer types (local control rate, 34.1% vs 81.8%; P < .01; pain progression-free rate, 36.9% vs 69.9%; P = .02). On multivariate analysis, colorectal cancer metastases and radiation history were identified as independent predictors of lower local and pain control rates. Radiation-induced myelopathy, radiculopathy, and vertebral compression fractures were observed in 0, 2 (1.5%), and 16 (11.9%) cases, respectively.Conclusions:This study showed that spine stereotactic body radiotherapy achieved good local and pain control, with a clinically acceptable safety profile. However, stereotactic body radiotherapy may be less effective against spinal metastases from colorectal cancer.

Clinical Outcomes of Stereotactic Body Radiotherapy for Patients With Stage I Small-Cell Lung Cancer: Analysis of a Subset of the Japanese Radiological Society Multi-Institutional SBRT Study Group Database

Stereotactic body radiotherapy (SBRT) is widely used as a curative treatment option for stage I non-small-cell lung cancer, but for patients with stage I small-cell lung cancer, the role of stereotactic body radiotherapy is unclear. In this study, we retrospectively analyzed the outcomes of a subset of patients with stage I small-cell lung cancer treated with stereotactic body radiotherapy in the database of the Japanese Radiological Society-Multi-Institutional stereotactic body radiotherapy Study Group. The 43 patients treated with stereotactic body radiotherapy for stage I small-cell lung cancer between 2004 and 2012 at 11 Japanese institutions were studied: median age = 77 years; 32 (74%) males and 11 females; and 80% were medically inoperable. The clinical stage was IA in 31 and IB in 12. In all patients, the lung tumors were pathologically proven as small-cell lung cancer. A total dose of 48 to 60 Gy was administered in 4 to 8 fractions. The median biologically effective dose (α/β = 10 Gy) was 105.6 Gy. Chemotherapy and prophylactic cranial irradiation were administered in only 8 patients, respectively. The median follow-up time was 23.2 months. The 2-year overall survival, progression-free survival, and distant metastasis-free survival rates were 72.3%, 44.6%, and 47.2%, respectively. The 2-year local control was 80.2%. Regarding the patterns of failure, distant metastasis, lymph node metastasis, and local recurrence were observed in 47%, 28%, and 16% of patients, respectively. No ≥grade 3 stereotactic body radiotherapy-related toxicities were observed. Although stereotactic body radiotherapy was thus revealed to be effective for the local control of stage I small-cell lung cancer, the incidence of distant metastases was high. Further investigations of larger cohorts are needed, including analyses of the effects of combined chemotherapy.

Stereotactic body radiotherapy (SBRT) for patients with locally advanced pancreatic cancer: A single center experience

IntroductionDespite advances in treatment, notably in systemic therapy, the prognosis of pancreatic adenocarcinoma (PADC) remains dismal. Stereotactic body radiotherapy (SBRT) is an emerging tool in the complex management of PADC. We review outcomes of SBRT for PADC at our institution. MethodsWe reviewed patients treated with SBRT for either unresectable PADC or locally recurrent PADC after surgery. Treatment was delivered using a robotic radiosurgery system with respiratory tracking. The median prescribed dose was 30 Gy (30–35 Gy), delivered in 5–6 fractions. Toxicities were reported as per CTCAE v4.0. Survival was estimated using the Kaplan–Meier method. ResultsBetween October 2010 and March 2016, 21 patients were treated at our institution. The median follow-up was 7 months (range: 1–28). The 1-year local control rate was 57%. The 1-year overall survival was 25% for locally advanced patients and 67% for those with local recurrences (p = 0.27). Eighty percent of cancer related deaths were due to metastatic progression. Five patients (24%) had Grade I–II gastrointestinal acute toxicity; one patient had fatal gastrointestinal bleeding 6 months after SBRT. ConclusionIn PADC, fractionated SBRT dose schedules near 30 Gy may strike the best balance of local control and bowel toxicity. More work is required to integrate pancreatic SBRT with modern systemic therapy.

Stereotactic body radiation therapy for isolated hilar and mediastinal non-small cell lung cancers

ObjectivesThe seminal phase II trial for pulmonary stereotactic body radiation therapy (SBRT) suggested that SBRT to central lesions resulted in unacceptable toxicity. Alternative dose-fractionation schemes have been proposed which may improve safety without compromise of efficacy. We report our institutional outcomes of SBRT for hilar/mediastinal non-small cell lung cancer (NSCLC). Materials and methodsA retrospective review was conducted of patients with NSCLC in a hilar or mediastinal nodal station which was treated with SBRT. Patients presented with a lesion involving the hilum or mediastinum from primary or oligorecurrent NSCLC. Kaplan-Meier with log-rank testing and Cox analysis were utilized for outcomes analysis. ResultsFrom 2008–2015, 40 patients with median age of 70 were treated with SBRT for primary/oligorecurrent hilar/mediastinal NSCLC with median follow-up of 16.4 months. 85% presented with oligorecurrent disease at a median of 22.4 months following definitive therapy. The aortico-pulmonary window was the target in 40%, the hilum in 25%, lower paratracheal in 20%, subcarinal in 10%, and prevascular in 5%. The median dose was 48Gy in 4 fractions (range: 35–48Gy in 4–5 fractions).Median overall (OS) and progression-free (PFS) survivals were 22.7 and 13.1 months, respectively. Two-year local control was 87.7% and not significantly different between hilar and mediastinal targets. Median PFS was significantly improved in patients with hilar vs mediastinal nodal targets: 33.3 vs 8.4 months, respectively (p=0.031). OS was not statistically different between hilar and mediastinal targets (p=0.359). On multivariable analysis, hilar vs mediastinal target predicted for PFS (HR 3.045 95%CI [1.044–8.833], p=0.042), as did shorter time to presentation in patients with oligorecurrence (HR 0.983 [95%CI 0.967–1.000], p=0.049). Acute grade 3+ morbidity was seen in 3 patients (hemoptysis, pericardial/pleural effusion, heart failure) and late grade 3+ morbidity (hemoptysis) in 1 patient. ConclusionHilar/mediastinal SBRT appears to be a safe technique for the local control of isolated nodal disease with limited toxicity from the fractionation schemes utilized.

P2.05-009 Outcome of Stereotactic Body Radiotherapy for Clinical Stage I Non Small Cell Lung Cancer and CT Findings: Comparison with Surgical Resection

The standard care for Stage I non small cell lung cancer (NSCLC) is surgical resection, but stereotactic body radiotherapy (SBRT) can be an alternative treatment option, especially for patients with comorbidities. However, it is difficult to compare the outcomes of SBRT with surgical resection because their characteristics are so different, and the risk factors for recurrence after SBRT are not fully understood. In this study, we report pretreatment clinical characteristics and CT findings in patients treated with SBRT, and reviewed patients underwent surgery with similar tumors.

P1.14-004 Outcomes of Stereotactic Body Radiotherapy and Surgery in Treating Early Stage Non-Small Cell Lung Cancer: A Meta-Analysis

P1.14-004 Outcomes of Stereotactic Body Radiotherapy and Surgery in Treating Early Stage Non-Small Cell Lung Cancer: A Meta-Analysis

WS4-3 - Current status and future prospects of stereotactic body radiotherapy for liver malignancies

Stereotactic body radiotherapy (SBRT) for liver malignancies is curative and safe treatment, but the definitive evidence is still lacking. In our institution, we reported high local control (3-year local control rate: 96%) and feasibility in prospective phase II study of SBRT for solitary HCC (≤4 cm) (Cancer 2016; 122: 2041-9). In addition, SBRT has specific characteristics; those are 1. Non-invasive therapy without pain or hemorrhage, 2. Easy to treat deep lesion in the body, 3.Little complication in relation with large vessel or biliary tract when treating those adjacent tumors, 4. Flexible dose strength based on the liver function and target volume. Because of those characteristics, we believe that SBRT plays an important role in the treatment for HCC, especially adjacent to or invading large vessel and just beneath diaphragm. Currently, in order to validate the efficacy and feasibility of SBRT for HCC, multicenter prospective study of SBRT for untreated solitary HCC (STRSPH study; UMIN000013011) is ongoing. Liver oligometastasis from colorectal cancer (OMCRC) is another disease that SBRT can play an important role. Although colorectal cancer is rather radio-resistant, we believe that SBRT can treat patients with OMCRC and result in good local control with feasibility. In fact, we reported excellent outcomes of SBRT for pulmonary and liver OMCRC with a total dose of 50-60 Gy in five fractions prescribed to the 60% isodose line of the maximum dose covering the surface of the planning target volume. The local control was 100% (J Radiat Res. 2016; 57: 400-5). Currently, in order to validate the efficacy and feasibility of SBRT for OMCRC, single institution prospective study of SBRT for OMCRC (UMIN000026577) is ongoing. We think radiation oncologists should show the efficacy and feasibility of SBRT for liver malignancies to let many clinician and patients understand SBRT.

Long-Term Results of Stereotactic Body Radiation Therapy for Patients With Small Hepatocellular Carcinoma Ineligible for Resection or Ablation Therapies

To evaluate the long-term outcome of stereotactic body radiotherapy (SBRT) in patients with small hepatocellular carcinoma (HCC) who are ineligible for resection or ablation therapies. We previously published the efficacy and safety of SBRT in 65 patients with 74 HCC who were ineligible for resection or ablation therapies. The following inclusion criteria for curative SBRT were used: (i) age over 20 years; (ii) an Eastern Cooperative Oncology Group Performance Status of 0–2; (iii) Child–Turcotte–Pugh (CTP) class A or B; (iv) less than three HCC nodules, each up to 50 mm in diameter without portal venous thrombosis or extrahepatic metastases; (v) inoperability because of poor general condition or surgery refusal; and (vi) unsuitability for radiofrequency ablation because of tumor location (on the liver surface, particularly high risk of pneumothorax, or near the porta hepatis), tumor invisibility on ultrasonography, or bleeding tendencies (platelet count, ≤50,000/mL; prothrombin activity, ≤50%). Patients were treated with the prescribed dose of 48 Gy in four fractions at the isocenter. CTP scoring was used to classify 56 and 9 patients into classes A and B, respectively. Local progression was defined as irradiated tumor growth on a dynamic computed tomography follow-up. Tumor responses were assessed according to the modified Response Evaluation Criteria in Solid Tumors. Treatment-related toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. We also updated the survival and tumor control outcomes for these same patients, with 2 years’ additional follow-up. In previous study, the median follow-up period was 26 months (range, 3–60), and 29 months in survivors (range, 16–60). The 2-year overall survival and local control rates were 76.0% (95% confidence interval [CI], 65.4–86.7%) and 100% (95% CI, 100%), respectively. In this study, the median follow-up period at the time of evaluation was 41 months (range, 3–73), and 58 months in survivors (range, 24–73). The 3-year and 5-year overall survival rates were 56.3% (95% CI, 44.1–68.5%) and 40.9% (95% CI, 28.0–53.8%), respectively. The 3-year and 5-year local control rates were both 100% (95% CI, 100%). Grade 3 or higher toxicities were observed in 15 (23.1%) patients. During the 2 years of additional follow-up period, the proportion of patients who had grade 3 or higher toxicities did not increase. The incidence of grade 3 or higher toxicities was higher in CTP class B than in class A (P = 0.0127). SBRT was effective and relatively safe for patients with small HCC who were ineligible for resection or ablation therapies even during longer follow-up times.

Video-assisted thoracoscopic lobectomy is associated with greater recurrence-free survival than stereotactic body radiotherapy for clinical stage I lung cancer

ObjectiveStereotactic body radiotherapy is the standard treatment for medically inoperable early-stage non–small cell lung cancer. Recent data suggest that in operable patients, stereotactic body radiotherapy produces outcomes comparable to those of surgical resection. In veterans with early non–small cell lung cancer, we compared the outcomes of stereotactic body radiotherapy and video-assisted thoracoscopic lobectomy. MethodsWe retrospectively reviewed data from 183 patients (94.0% male) with clinical stage I non–small cell lung cancer who underwent stereotactic body radiotherapy (n = 56) or video-assisted thoracoscopic lobectomy (n = 127) from 2009 to 2014. Propensity matching was used to produce more comparable groups. Primary end points were tumor control and overall, recurrence-free, and lung-cancer–specific survival, as estimated by Kaplan–Meier actuarial analysis. Multivariable analysis was used to identify independent predictors. ResultsIn the overall cohort, the patients who received stereotactic body radiotherapy were older than the patients who received video-assisted thoracoscopic lobectomy (median age, 79.5 vs 64 years) and had more comorbidities. In the 37 propensity-matched pairs, the 3-year actuarial tumor control rate was 54.3% after stereotactic body radiotherapy and 90.6% after video-assisted thoracoscopic lobectomy (P = .0038). Actuarial lung cancer–specific 3-year survival was 78.1% (stereotactic body radiotherapy) versus 93.6% (video-assisted thoracoscopic lobectomy) (P = .055). One-year overall, 3-year overall, and 3-year recurrence-free survivals were 89.2%, 52.9%, and 38.5% after stereotactic body radiotherapy and 94.6%, 85.7%, and 82.8% after video-assisted thoracoscopic lobectomy (P < .005 for all), respectively. In multivariable analysis, stereotactic body radiotherapy independently predicted recurrence and poorer survival. ConclusionsIn veteran patients with early-stage non–small cell lung cancer, video-assisted thoracoscopic lobectomy resulted in better disease control and survival than stereotactic body radiotherapy. Although prior reports suggest that stereotactic body radiotherapy is a suitable alternative to surgery in early-stage lung cancer, a prospective randomized trial is needed. Nevertheless, stereotactic body radiotherapy remains a suitable option for medically inoperable patients.

Clinical outcomes of stereotactic body radiotherapy for elderly patients with hepatocellular carcinoma.

To evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for the treatment of hepatocellular carcinoma (HCC) in elderly patients. From 2008 to 2015, 117 patients with HCC (≤3 nodules, ≤30mm in diameter, Child-Pugh score ≤7, and no vascular or extracellular metastasis) were treated with SBRT at our hospital. We evaluated overall survival (OS), disease-free survival (DFS), local control, and adverse events. Patients were stratified according to age 75years and older (elderly group, n = 54) and age younger than 75years (young group, n = 63). The median OS in the elderly group was not significantly different from that in the young group (52months vs. not reached, P = 0.27). The 1-, 2-, and 3-year OS rates were 96.2%, 77.6%, and 63.9%, respectively, in the elderly group, and 96.8%, 84.8%, and 67.7%, respectively, in the young group. The median DFS in the elderly group was significantly shorter than that in the young group (13 vs. 25months, respectively; P = 0.03). The 1-, 2-, and 3-year DFS rates were 50.6%, 30.4%, and 26.6%, respectively, in the elderly group and 66.5%, 50.7%, and 45.3%, respectively, in the young group. The 3-year local tumor control rate in the elderly group was 98.1%, and that in the young group was 98.4% (P = 0.83). There was no difference between groups in the incidence of any adverse events. Stereotactic body radiotherapy can be effective and safe for the treatment of HCC in elderly patients.

Stereotactic body radiation therapy to generate comparable survival to surgery in treating hepatocellular carcinoma (HCC): Results of 756 patients.

4080 Background: Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable treatment option in patients with hepatocellular carcinoma (HCC). This study aimed to compare survival outcomes after SBRT with other front line local treatments for HCC. Methods: This is a retrospective analysis of patients identified through our cancer registry from 2000 to 2016. Patients treated with any local therapy alone were eligible: SBRT, surgery, conventional external beam radiation (CEBRT), and other local therapies including brachytherapy. Patients treated with combined therapies such as SBRT plus liver transplant were excluded. The primary endpoint was overall survival which was estimated from the time of diagnosis. Differences between the groups were compared using log-rank test. The data are presented as median (95%CI). Results: A total of 756 patients with a median follow-up of 45 months (mo) met the selection criteria: 116, 380, 43, and 217 patients received SBRT, surgery, CEBRT, and other local treatment, respectively. Median age was 61, 60, 61 and 60 years, respectively. The median overall survival/3 year overall survival rate were 49 (32-66) mo /53% (44-65%) for patients treated with SBRT, which were not significantly different from 75 (57-94) mo /63% (58-69%) of surgery (p = 0.27), non-significantly better than 22 (13-31) mo /41% (27-60%) of CEBRT (p = 0.13), significantly better than 15 (13-20) mo /26% (20-34%) of other local treatments (p = 3×10-7). After adjusting for significant prognostic factors including age, race, status of tobacco abuse, history of alcohol use, tumor size, histology grade and stage, the survival outcomes of SBRT remained to be insignificantly different from surgery (HR = 0.8, p = 0.2), have a trend of significant difference from CEBRT (HR = 1.4, p = 0.1) and remarkably superior to that of other local treatments (HR = 1.8, p = 2×10-4). Conclusions: This study suggests that SBRT is an excellent front line option for HCC, potentially comparable to surgical resection and associated with longer survival than other front line local treatments. Randomized studies are needed to validate these findings.