Role Of Stereotactic Body Radiation Therapy Research Articles

Local ablative stereotactic body radiotherapy for oligometastatic prostate cancer.

The oligometastases is considered an intermediate state of the disease between localized and wide spread metastases. Local ablative therapy to oligometastatic prostate cancer is gaining significant traction and stereotactic body radiotherapy (SBRT) is an emerging treatment modality for this patient population. In this review, we report our literature review of SBRT to prostate oligometastases. Current evidence on the role of SBRT in oligometastatic prostate cancer reported in the last 10 years was summarized. Criteria for inclusion included studies with prostate cancer only as the primary site. The unique properties of the oligometastatic prostate cancer appear to carry a better prognosis than wide spread metastatic disease, especially if these metastases are amenable to local ablative therapies. Our literature review revealed that local ablative therapy, using SBRT to prostate oligometastases, is associated with significant 2-years local control and acceptable toxicity profile. SBRT to oligometastatic prostate cancer patients is feasible and carries an acceptable toxicity profile. The randomized phase II and III trials, currently underway, should clearly define the real benefit of this approach on progression-free and overall survival outcomes.

Stereotactic Body Radiotherapy for Centrally Located Non-small Cell Lung Cancer

已有的少数研究表明，早期不可手术非小细胞肺癌立体定向放射治疗肿瘤局控率可超过90%，患者中位生存时间和总生存率接近外科手术治疗。近年来立体定向放射治疗已成为Ⅰ期不可手术周围型非小细胞肺癌患者的推荐治疗。但中央型肺癌因其解剖位置多毗邻纵隔内重要脏器，常可伴有更明显的放疗副反应。中央型肺癌是否能进行立体定向放射治疗目前尚无统一定论，本文主要对中央型非小细胞肺癌立体定向放射治疗的定义、适应症、剂量分割方式、危及器官剂量-体积限制、放疗技术支持、副反应及立体定向质子治疗进行综述。

Patterns of failure in a phase II trial of neoadjuvant chemotherapy and stereotactic body radiation therapy (SBRT) for resectable and borderline resectable (BLR) pancreatic cancer.

482 Background: There is emerging interest in the role of SBRT in locally advanced pancreas cancer, however little prospective data exists examining the safety, efficacy, and optimal target volumes for SBRT in the neoadjuvant setting for resectable or BLR pancreatic cancer. Methods: Eighteen patients were enrolled from 11/2014-6/2017. SBRT was delivered to the tumor and abutting vessel with fiducials/compression and a 3 mm PTV margin to 33 Gy (6.6 Gyx5fxn) with an optional elective PTV to 25 Gy (5 Gyx5fxn) customized to the nodal space and mesenteric vessels. Patients without progression underwent surgery 4-6 weeks following SBRT. The primary endpoint is ≥ Grade 3 acute and late GI toxicity. Secondary endpoints included overall survival (OS), progression-free survival (PFS),and cumulative incidence of local failure (LF). LF is defined as recurrence within conventional RT volumes from the time of resection to local failure or last CT with no progression. Local failures were fused to planning CTs for dose quantification. Results: Thirteen patients had BLR tumors due to arterial abutment (n = 7) or SMV encasement (n = 8); 3 patients had resectable tumors. All patients received 4 months of gemcitabine/nab-paclitaxel (n = 13) or FOLFIRNOX (n = 5) prior to SBRT. There were no ≥ Grade 3 acute or late GI events. Metastases were noted in 6 patients (33%) at restaging or surgery. Surgery was performed in 12 patients (67%) with 11 (92%) R0 resections. Median OS and PFS are 21 months and 11 months, respectively. Progression occurred in 67% (8/12) of resected patients with first site of failure as distant (n = 3, 38%), local only (n = 4, 50%), and local and distant (n = 1,13%). The cumulative incidence of LF at 12 months from resection was 50%. All LF were outside to the PTV33 with median D90 of 11.5 Gy (4-25 Gy), V25 Gy of 51% (0-90%), and V33 Gy of 45% (0-52%). Conclusions: SBRT as a component of neoadjuvant therapy was well tolerated. However, local failures were predominantly observed outside the PTV33 volume within conventional RT volumes. Therefore, the durability of local control after SBRT in the neoadjuvant setting relative to chemoradiation merits close examination. Clinical trial information: NCT02208024.

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: Does It Have a Role in Management of Hepatocellular Carcinoma?

Stereotactic body radiotherapy (SBRT) is a form of radiotherapy that delivers high doses of irradiation with high precision in a small number of fractions. However, it has not frequently been performed for the liver due to the risk of radiation-induced liver toxicity. Furthermore, liver SBRT is cumbersome because it requires accurate patient repositioning, target localization, control of breathing-related motion, and confers a toxicity risk to the small bowel. Recently, with the advancement of modern technologies including intensity-modulated RT and image-guided RT, SBRT has been shown to significantly improve local control and survival outcomes for hepatocellular carcinoma (HCC), specifically those unfit for other local therapies. While it can be used as a stand-alone treatment for those patients, it can also be applied either as an alternative or as an adjunct to other HCC therapies (e.g., transarterial chemoembolization, and radiofrequency ablation). SBRT might be an effective and safe bridging therapy for patients awaiting liver transplantation. Furthermore, in recent studies, SBRT has been shown to have a potential role as an immunostimulator, supporting the novel combination strategy of immunoradiotherapy for HCC. In this review, the role of SBRT with some technical issues is discussed. In addition, future implications of SBRT as an immunostimulator are considered.

The role of stereotactic body radiotherapy in reirradiation of head and neck cancer recurrence.

Head and neck cancer recurrence is a therapeutic challenge due to the anatomical and functional constraints of the head and neck area. Stereotactic body radiotherapy (SBRT) is a high-precision technique of radiotherapy that consists of delivering a high ablative biological dose in 1-5 high-dose fractions, requiring a very high precision of the radiotherapy process with potential application in this clinical setting METHODS: Different studies that investigate the role of SBRT in the treatment of recurrent head and neck cancer have been reviewed. Indications to properly select patients for this treatment are presented. Retrospective studies and phase I-II trials with selected patients have shown low to moderate toxicity, with an efficacy at least similar to that of treatment with combinations of radiotherapy and chemotherapy. In selected patients, SBRT is a treatment option for recurrent head and neck cancer with low toxicity. New prospective studies should clarify data regarding the efficacy and toxicity of SBRT in head and neck cancer recurrence.

PC 01.01 SABR as First Line Treatment Option

SBRT for small-sized non-small cell lung cancer: Surgery has historically been the primary treatment option for patients with Stage I non–small-cell lung cancer (NSCLC). Although Stage I NSCLC is technically curable, the presence of significant co morbidity increases the risk of postoperative complications and reduces the potential role of surgery even early stage NSCLC. Because nonsurgical treatment options such as conventional radiotherapy have historically achieved suboptimal outcomes, some have argued that the risks associated with surgery in patients with severe COPD were justified. The reason for poor tumor control with conventional radiation therapy has been shown to be due to insufficient total radiation doses, which is usually 60 Gy or lower. Dose escalation with CRT have shown that a total dose of just above 80 Gy seems to be tolerable while doses exceeding 90 Gy, necessary for optimal tumor control, were associated with high risk of unacceptable lung toxicity. Since the 2000s, stereotactic body radiation therapy has rapidly spread as medical physics improved. Stereotactic body radiation therapy has been revealed to be equivalent to surgery in tumor ablation. With stereotactic body radiotherapy (SBRT) the radiation dose to normal tissue is minimized and the dose per fraction can be increased resulting in biologic doses up to twice as high as in CRT. This has resulted in improvement of local tumor control rates up to 88% to 100%, comparable to the rates after surgery. SBRT is a safe and effective treatment option for these patients, with outcomes that do not appear to be inferior to surgery. SBRT is not associated with the considerable initial risks of operative mortality and prolonged hospitalization. Patients who do undergo surgery may benefit from avoiding open lobectomy, instead using less invasive approaches such as video-assisted thoracoscopic surgery or open segmentectomy. All patients with Stage I NSCLC and severe COPD should be evaluated in a multidisciplinary setting and afforded an informed decision of the risks and benefits of both surgery and SBRT. In role of SBRT can also be extended even in patients with oligometastases and oligo-recurrence, the oligometastases and oligo-recurrence who sometimes cured with only local therapy. Radiotherapy (RT) can cause immunogenic tumor cell death resulting in cross-priming of tumor-specific T-cells, acting as an in situ tumor vaccine; however, SBRT alone has limit in inducing effective anti-tumor immunity resulting in systemic tumor rejection. Immunotherapy can complement SBRT to help overcome tumor-induced immune suppression, as demonstrated in many pre-clinical tumor models. There are many trials underway for combinations of different immunotherapies and SBRT. SBRT, early stage NSCLC, inoperable

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma-a multicenter analysis of the German working group "Stereotactic Radiotherapy".

Renal cell carcinoma (RCC) is traditionally considered to be radioresistant. Radiotherapy response rates are believed to improve with hypofractionated, high dose stereotactic body radiotherapy (SBRT). However, limited data exist regarding the role of SBRT in the treatment of pulmonary metastases. The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology analyzed its multi-institutional database of more than 700 patients who received SBRT for pulmonary metastases. Treatment was performed at 10 centers between 2001 and 2016. Patients with metastatic RCC were included in the study. Tumor characteristics, treatment details, and follow-up data including survival, local control (LC), distant metastases, and toxicity were evaluated. A total of 46 RCC patients treated with SBRT for 67 lung metastases were identified, who received a median total biologically effective dose (BEDiso) at planning target volume (PTV) isocenter of 117.0 Gy (range, 48.0-189.0 Gy). A median fractional dose of 20.8 Gy at isocenter (range, 6.0-37.9 Gy) was administered in a median number of 3 fractions (1-8 fractions). After a median follow-up time of 28.3 months for all patients, 1- and 3-year LC rates were 98.1% and 91.9%, with corresponding 1- and 3-year overall survival (OS) of 84.3% and 43.8%, respectively. Pulmonary metastases treated with BEDiso ≥130 Gy showed a trend for superior LC (P=0.054). OS was significantly improved in both uni- and multivariate analysis for patients with higher Karnofsky performance scale, lower maximum pulmonary metastasis diameter and lack of post-SBRT systemic therapy due to progression (P=0.014; P=0.049; P=0.006). Only mild acute and late toxicity was reported. SBRT for pulmonary metastases from RCC was associated with low treatment-associated toxicity, promising survival, and excellent LC, especially in those patients receiving a BEDiso ≥130 Gy.

Role of Stereotactic Body Radiotherapy in the Treatment of Elderly and Poor Performance Status Patients With Pancreatic Cancer.

Literature on the management of nonmetastatic pancreatic ductal adenocarcinoma in patients who are elderly or have poor performance status is sparse. The median survival of this unique cohort of patients is < 6 months, and most patients are only offered single-agent gemcitabine or supportive care. Recently, adding nanoparticle albumin-bound paclitaxel to gemcitabine was shown to improve survival of patients with metastatic disease with Eastern Cooperative Group performance status of 2. Although standard chemoradiotherapy provides long-term locoregional control in locally advanced pancreatic cancer, it is difficult for this group of patients to tolerate 6 weeks of therapy. Stereotactic body radiotherapy (SBRT) can be delivered in only 3 to 5 days, does not require concurrent chemotherapy, and has limited toxicity, and tumor control rates appear to be equivalent to or better than those achieved with standard chemoradiotherapy. Additionally, SBRT has been shown to improve cancer-related pain and patient-reported quality of life. Given the favorable toxicity profile, SBRT seems like an obvious choice for patients who are elderly, have multiple comorbidities, or have poor performance status. Herein, we review the literature on SBRT in this unique patient population and discuss future directions.

Management of high-risk prostate cancer with 5-treatment stereotactic body radiotherapy: Long-term results.

94 Background: Stereotactic Body Radiotherapy (SBRT) is an emerging treatment modality with excellent control rates for low- and intermediate-risk prostate cancer. The role of SBRT for high-risk disease, however, is less studied. The standard treatment (RT) for high-risk prostate cancer entails 8-9 weeks of daily RT with long-term androgen deprivation therapy (ADT). In comparison to this, SBRT is completed in 5 sessions, and offers convenience, low toxicity, and equivalent biochemical disease control rates as standard RT in the low- and intermediate-risk setting. We now present long-term results for SBRT in a cohort of patients with high-risk disease. Methods: We evaluated patients treated from 2006-2010 with SBRT alone (n = 52) to dose of 35-36.25 Gy in 5 fractions, or pelvic radiation to 45 Gy followed by SBRT boost of 19-21 Gy in 3 fractions (n = 46). Androgen deprivation therapy was administered to 55% of patients. Quality of life and bladder/bowel toxicity was assessed using the Expanded Prostate Index Composite (EPIC) and RTOG toxicity scale at regular time intervals. Results: Median followup was 84 months. 8-year biochemical disease-free survival (bDFS) was 61.3%. On univariate analyses,PSA was significant for bDFS (p = 0.001), whereas pelvic radiation (p = 0.97), T-stage (p = 0.79), ADT (p = 0.77), Gleason score (p = 0.78) were not. On multivariate analysis, only PSA remained significant (p = 0.003) for bDFS. Overall toxicity was mild, with 5.1% Grade 2 urinary, 3% Grade 3 urinary and 7.1% Grade 2 bowel toxicity. Use of pelvic radiotherapy was associated with significantly higher bowel toxicity (p = .001). EPIC bowel and bladder scores declined for the first six months and then returned towards baseline. Conclusions: Five-treatment SBRT appears to be a safe and effective treatment for high-risk prostate carcinoma now with median 84 month follow up. The addition of pelvic radiation or ADT does not confer any bDFS benefit with this modality. Our data suggests that SBRT alone may be the optimal approach. SBRT may be a good treatment alternative to discuss particularly for patients unable to undergo ADT or unwilling to receive standard 8-9 week RT. Prospective studies are required to corroborate our results.

Clinical Outcomes of Stereotactic Body Radiotherapy in Oligometastatic Gynecological Cancer.

The objective of this study was to assess the role of stereotactic body radiotherapy (SBRT) in the treatment of distantly recurrent, oligometastatic gynecological cancer. The hospital records of 45 patients with F-fluorodeoxyglucose (F-FDG) positron emission tomography positive, distantly recurrent, oligometastatic gynecological cancer were reviewed. All these patients had a number of target lesions less than 5, with largest diameter less than 6 cm. The treatment was delivered with a TrueBeam LINAC and RapidArc technique, using 10 or 6 MV FFF beams. A total of 70 lesions were treated, and lymph nodes represented the most common site of metastases, followed by lung, liver, and soft tissues. Twenty lesions were treated with one single fraction of 24 Gy and 5 lesions received 27 Gy delivered in 3 fractions, depending on the ability to fulfill adequate target coverage and safe dose/volume constraints for the organ at risk with either regimen. Positron emission tomography scan 3 months after SBRT showed a complete response (CR) in 45 lesions (64.3%), a partial response in 14 (20.0%), a stable disease in 5 (7.1%), and a progressive disease in 6 (8.6%). No lesions in CR after SBRT subsequently progressed. Overall acute toxicity occurred in 13 (28.9%) patients. The most common grade 1 to 2 adverse event was pain (n = 9, 20.0%), followed by nausea and vomiting (n = 5, 11.1%). No grade 3 to 4 acute toxicities occurred, and no late toxicities were observed. Patients who failed to achieve a CR had a 2.37-fold higher risk of progression and a 3.60-fold higher risk of death compared with complete responders (P = 0.04 and P = 0.03, respectively). Stereotactic body radiotherapy offers an effective and safe approach for selected cases of oligometastatic gynecological cancer.

Stereotactic body radiotherapy for hepatocellular carcinoma in the setting of poor liver function: A case series.

493 Background: Role of stereotactic body radiotherapy (SBRT) to the liver for patients with poor hepatic function after transcatheter arterial chemoembolization (TACE) has not been established. We reviewed results of SBRT for men with hepatocellular carcinoma (HCC) and Child-Pugh (CP) score ≥ 8 cirrhosis after TACE. Methods: Following a median of 3 TACE treatments, five males with severe cirrhosis received SBRT for persistent or progressive HCC in 2011-14. Clinico-pathologic characteristics and treatment details were retrospectively retrieved. Results: Median age at diagnosis was 55 years (range, 48 – 55). Median interval between cancer diagnosis and SBRT was 38 months (range, 3 – 60). All 5 patients experienced decline in CP score after TACE, for a median of drop of 1 point (range, 1 – 3) between the initiation of TACE and referral for radiotherapy. At time of SBRT, 4 had CP class B and 1 class C cirrhosis with median CP score of 9 (range, 8 – 11). There were no distant metastases and one patient had extrahepatic tumor extension. Three of 5 exhibited clinical symptoms of decompensated cirrhosis within 30 days before radiotherapy and one had portal vein thrombosis. Median MELD score at SBRT was 15 (range, 12 – 18). SBRT to a median total dose of 27.5 Gray (range, 27.5 – 30) was delivered in 5 once daily fractions. Median radiotherapy course duration was 9 days (range, 5 – 18). All patients had single radiation therapy targets with median largest tumor dimension of 3.6 cm (range, 2.4 – 6.2). Median planned target volume was 24 cm3(range, 17 – 197). Sorafenib was given prior to SBRT to one patient, concurrently to one, and sequentially after radiotherapy to another. There were no acute complications. Two patients died within 20 days from completion of SBRT. Median follow up for surviving &gt; 20 days was 10 months (range, 5 – 13). None experienced radiographic tumor progression after radiotherapy. Estimated overall survival was 40% at 6 months (95% confidence intervals, 0 – 83.8%). Conclusions: For HCC patients with CP score ≥ 8 following TACE, prognosis after liver SBRT was poor.

Stereotactic Body Radiotherapy in Patients with Lung Oligometastases from Colorectal Cancer.

To assess the role of stereotactic body radiotherapy (SBRT) in pulmonary metastases from colorectal cancer (CRC). Thirty-three consecutive patients with pulmonary metastases from CRC who received SBRT were included in the analysis. The primary endpoints were local and systemic progression-free survival, a secondary endpoint was the safety profile of SBRT. A total of 56 lesions were treated with SBRT. A single nodule was treated in 15 patients, two in 13 and three in five. The radiotherapy dose and the adopted fractionations were 24-27 Gy as a single fraction for 40 lesions and 27-42 Gy in three fractions (2-3 times a week) for the other 16 lesions. After a median follow-up of 22.8 months (range=1.3-45.7 months), the median progression-free survival of the irradiated sites was 13.4 months. SBRT can be considered as local therapy in patients with lung metastases from CRC.

What is the role of stereotactic body radiotherapy to treat inoperable hepatocellular carcinoma

Wahl et al ., in a recent retrospective analysis, compared patients with inoperable, non-metastatic hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) or stereotactic body radiotherapy (SBRT) (1). Over an 8 years’ time period, there were 161 in the RFA group and 63 patients in the SBRT group. Treatment plans were made based on multidisciplinary tumor board review. The two groups were similar in tumor size and number of lesions treated per patient. However, the SBRT group had lower Child-Pugh scores and had more prior liver directed treatments. Overall one-year survival was 70% in the RFA group and 74% in the SBRT group. There was no statistically significant difference in complication rates between the two groups. For tumors >2 cm, the freedom from local progression (FFLP) was worse in the RFA group than the SBRT group (P=0.025). From this finding, the authors concluded that SBRT should be first line treatment for inoperable, larger HCC. This is an important study that examines the role for SBRT in the treatment of HCC. However, the overall conclusion that SBRT is a reasonable first-line treatment of inoperable, larger HCC is premature and is not justified by the data.

What is the role of stereotactic body radiotherapy to treat inoperable hepatocellular carcinoma?

What is the role of stereotactic body radiotherapy to treat inoperable hepatocellular carcinoma?

The role of SBRT in oligometastatic patients with liver metastases from breast cancer

Liver metastases from breast cancer are a common occurrence. Local ablative therapies are a promising therapeutic option for these patients, with the potential for a long term disease control in the setting of “oligometastatic patients”. Identification of the perfect candidate for local approaches is still challenging and unclear. Stereotactic body radiation therapy (SBRT) is one of the most valuable local therapy, because of great efficiency, low morbidity and minimal invasiveness. In this paper, we reviewed the state of the art in the care of breast cancer patients with liver metastases, with a focus on SBRT.

Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer.

Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is a technique of external beam radiation that delivers precisely targeted, ablative doses to extracranial sites. It has become an integral component of the management of early-stage non-small cell lung cancer (NSCLC). In this review, we discuss the technology and techniques used in treatment planning and delivery, the efficacy and toxicity of SBRT for medically inoperable early-stage NSCLC, and the preliminary investigations into the role of SBRT for operable early-stage NSCLC.

Post operative stereotactic radiosurgery for positive or close margins after preoperative chemoradiation and surgery for rectal cancer.

The incidence of positive margins after neoadjuvant chemoradiation and adequate surgery is very low. However, when patients do present with positive or close margins, they are at a risk of local failure and local therapy options are limited. We evaluated the role of stereotactic body radiotherapy (SBRT) in patients with positive or close margins after induction chemoradiation and total mesorectal excision. This is a retrospective evaluation of patients treated with SBRT after induction chemoradiation and surgery for positive or close margins. Seven evaluable patients were included. Fiducial seeds were place at surgery. The Cyberknife(TM) system was used for planning and treatment. Patients were followed 1 month after treatment and 3-6 months thereafter. Descriptive statistics and Kaplan-Meir method was used to repot the findings. Seven patients (3 men and 4 women) were included in the study with a median follow-up of 23.5 months. The median initial radiation dose was 5,040 cGy (in 28 fractions) and the median SBRT dose was 2,500 cGy (in 5 fractions). The local control at 2 years was 100%. The overall survival at 1 and 2 years was 100% and 71% respectively. There was no Grade III or IV toxicity. SBRT reirradiation is an effective and safe method to address positive or close margins after neoadjuvant chemoradiation and surgery for rectal cancer.

Role of SBRT with VMAT technique and FFF beams for lymph-node metastases in oligometastatic patients from genitourinary malignancies.

e16136Background: Stereotactic body radiotherapy (SBRT) is an interesting therapeutic approach for several sites of metastatic disease but few published data exist on local control rates in the con...

Stereotactic Body Radiotherapy for T3N0 Lung Cancer With Chest Wall Invasion

IntroductionThe role of stereotactic body radiotherapy (SBRT) for tumors involving the chest wall (CW) remains ill-defined. The Radiation Therapy Oncology Group 0236 trial allowed inclusion of T3N0 non–small-cell lung cancer (NSCLC) < 5 cm, although ultimately none were enrolled. No published data set investigating this population is available. Materials and MethodsWe queried an institutional review board-approved prospective SBRT registry to identify patients with tumors involving the CW, defined as radiographic evidence of frank soft tissue invasion or bony destruction. All patients underwent SBRT to a median dose of 50 Gy in 5 fractions and were followed up for tumor control, pain response, and toxicity. ResultsOf 820 NSCLC patients reviewed, 13 with CW involvement were identified. Of these 13 patients, 10 had primary T3N0 NSCLC and 3 had recurrent NSCLC. Their median age was 78 years, the Karnofsky performance status was 80, the Charlson score was 3, and the tumor diameter was 4.0 cm. The 1-year local, locoregional, and distant control rates were 89%, 62%, 80%, respectively. Of 9 patients with pretreatment tumor-related CW pain, 7 (78%) reported improvement after treatment. Regarding toxicity, 2 of 13 (15%) experienced new or worsening CW pain (both grade ≤ 2); 3 cases (23%) of grade 1-2 radiation pneumonitis developed. No patient exhibited late skin changes or fibrosis. ConclusionSBRT for NSCLC involving the CW was well tolerated, with promising early rates of tumor control and no grade ≥ 3 toxicity. Tumor-related CW pain was relieved in most patients, and the treatment-related toxicity rates appeared acceptable. Further investigation in this subset of patients with NSCLC is warranted.