Once-Weekly, High-Dose Stereotactic Body Radiotherapy for Lung Cancer: 6-Year Analysis of 60 Early-Stage, 42 Locally Advanced, and 7 Metastatic Lung Cancers

PURPOSE Patients with centrally located early-stage non–small-cell lung cancer (NSCLC) are at a higher risk of toxicity from high-dose ablative radiotherapy. NRG Oncology/RTOG 0813 was a phase I/II study designed to determine the maximum tolerated dose (MTD), efficacy, and toxicity of stereotactic body radiotherapy (SBRT) for centrally located NSCLC. MATERIALS AND METHODS Medically inoperable patients with biopsy-proven, positron emission tomography–staged T1 to 2 (≤ 5 cm) N0M0 centrally located NSCLC were accrued into a dose-escalating, five-fraction SBRT schedule that ranged from 10 to 12 Gy/fraction (fx) delivered over 1.5 to 2 weeks. Dose-limiting toxicity (DLT) was defined as any treatment-related grade 3 or worse predefined toxicity that occurred within the first year. MTD was defined as the SBRT dose at which the probability of DLT was closest to 20% without exceeding it. RESULTS One hundred twenty patients were accrued between February 2009 and September 2013. Patients were elderly, there were slightly more females, and the majority had a performance status of 0 to 1. Most cancers were T1 (65%) and squamous cell (45%). Organs closest to planning target volume/most at risk were the main bronchus and large vessels. Median follow-up was 37.9 months. Five patients experienced DLTs; MTD was 12.0 Gy/fx, which had a probability of a DLT of 7.2% (95% CI, 2.8% to 14.5%). Two-year rates for the 71 evaluable patients in the 11.5 and 12.0 Gy/fx cohorts were local control, 89.4% (90% CI, 81.6% to 97.4%) and 87.9% (90% CI, 78.8% to 97.0%); overall survival, 67.9% (95% CI, 50.4% to 80.3%) and 72.7% (95% CI, 54.1% to 84.8%); and progression-free survival, 52.2% (95% CI, 35.3% to 66.6%) and 54.5% (95% CI, 36.3% to 69.6%), respectively. CONCLUSION The MTD for this study was 12.0 Gy/fx; it was associated with 7.2% DLTs and high rates of tumor control. Outcomes in this medically inoperable group of mostly elderly patients with comorbidities were comparable with that of patients with peripheral early-stage tumors.

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34 A retrospective review of a unique high dose palliative radiotherapy fractionation regime for locally advanced and metastatic lung cancer at Mount Vernon Hospital

Lung Cancer ◽

10.1016/s0169-5002(07)70360-4 ◽

2007 ◽

Vol 57 ◽

pp. S10

Author(s):

C. Corner ◽

H. Simonds ◽

J. Dickson ◽

A.M. Rojas

Keyword(s):

Lung Cancer ◽

Retrospective Review ◽

Locally Advanced ◽

Palliative Radiotherapy ◽

High Dose ◽

Metastatic Lung Cancer ◽

Mount Vernon ◽

Metastatic Lung

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Stereotactic body radiotherapy versus conventional radiotherapy for early-stage small cell lung cancer

Journal of Radiation Oncology ◽

10.1007/s13566-019-00395-x ◽

2019 ◽

Vol 8 (2) ◽

pp. 239-248 ◽

Cited By ~ 1

Author(s):

Neil B. Newman ◽

Alexander D. Sherry ◽

Daniel W. Byrne ◽

Evan C. Osmundson

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Stereotactic Body Radiotherapy ◽

Early Stage ◽

Small Cell ◽

Small Cell Lung ◽

Conventional Radiotherapy

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The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Cancers ◽

10.3390/cancers13153711 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3711

Author(s):

François Montagne ◽

Florian Guisier ◽

Nicolas Venissac ◽

Jean-Marc Baste

Keyword(s):

Lung Cancer ◽

Residual Disease ◽

State Of The Art ◽

Locally Advanced ◽

Small Cell Lung ◽

Lung Cancers ◽

Screening Programs ◽

Systemic Therapies

Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients’ characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients’ comfort.

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Comparison of Oncologic Outcomes between Carbon Ion Radiotherapy and Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer

Cancers ◽

10.3390/cancers13020176 ◽

2021 ◽

Vol 13 (2) ◽

pp. 176

Author(s):

Yuhei Miyasaka ◽

Shuichiro Komatsu ◽

Takanori Abe ◽

Nobuteru Kubo ◽

Naoko Okano ◽

...

Keyword(s):

Lung Cancer ◽

Propensity Score ◽

Small Cell Lung Cancer ◽

Stereotactic Body Radiotherapy ◽

Early Stage ◽

Small Cell ◽

Oncologic Outcomes ◽

Comparison Study ◽

Small Cell Lung ◽

Early Stage Nsclc

Lung cancer is a leading cause of cancer-related deaths worldwide. Radiotherapy is an essential treatment modality for inoperable non-small cell lung cancer (NSCLC). Stereotactic body radiotherapy (SBRT) is the standard treatment for early-stage NSCLC because of its favorable local control (LC) compared to conventional radiotherapy. Carbon ion radiotherapy (CIRT) is a kind of external beam radiotherapy characterized by a steeper dose distribution and higher biological effectiveness. Several prospective studies have shown favorable outcomes. However, there is no direct comparison study between CIRT and SBRT to determine their benefits in the management of early-stage NSCLC. Thus, we conducted a retrospective, single-institutional, and contemporaneous comparison study, including propensity score-adjusted analyses, to clarify the differences in oncologic outcomes. The 3-year overall survival (OS) was 80.1% in CIRT and 71.6% in SBRT (p = 0.0077). The 3-year LC was 87.7% in the CIRT group and 79.1% in the SBRT group (p = 0.037). Multivariable analyses showed favorable OS and LC in the CIRT group (hazard risk [HR] = 0.41, p = 0.047; HR = 0.30, p = 0.040, respectively). Log-rank tests after propensity score matching and Cox regression analyses using propensity score confirmed these results. These data provided a positive efficacy profile of CIRT for early-stage NSCLC.

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