Journal article
Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer
International journal of radiation oncology, biology, physics, Vol.97(2), pp.362-371
02/01/2017
DOI: 10.1016/j.ijrobp.2016.10.041
PMID: 28011047
Abstract
For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population.
The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes.
From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and "elsewhere lung" (20.8%). The median time to each was 5 to 7 months.
From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.
Details
- Title: Subtitle
- Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer
- Creators
- Vivek Verma - Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NebraskaCharles B Simone II - Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PennsylvaniaPamela K Allen - Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TexasSameer R Gajjar - Baylor College of Medicine, Houston, TexasChirag Shah - Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OhioWeining Zhen - Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NebraskaMatthew M Harkenrider - Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, IllinoisChristopher L Hallemeier - Department of Radiation Oncology, Mayo Clinic, Rochester, MinnesotaSalma K Jabbour - Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New JerseyChance L Matthiesen - Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OklahomaSteve E Braunstein - Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CaliforniaPercy Lee - Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaThomas J Dilling - Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FloridaBryan G Allen - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IowaElizabeth M Nichols - Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MarylandAlbert Attia - Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TennesseeJing Zeng - Department of Radiation Oncology, University of Washington Medical Center, Seattle, WashingtonTithi Biswas - Department of Radiation Oncology, University Hospitals Siedman Cancer Center, Case Western Reserve University, Cleveland, OhioPeter Paximadis - Division of Radiation Oncology, Department of Oncology, Barbara Ann Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, MichiganFen Wang - Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KansasJoshua M Walker - Department of Radiation Medicine, Oregon Health & Science University, Portland, OregonJohn M Stahl - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, ConnecticutMegan E Daly - Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CaliforniaRoy H Decker - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, ConnecticutRussell K Hales - Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MarylandHenning Willers - Department of Radiation Oncology, Massachusetts General Hospital, Boston, MassachusettsGregory M M Videtic - Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OhioMinesh P Mehta - Miami Cancer Institute, Baptist Health South Florida, Coral Gables, FloridaSteven H Lin - Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: shlin@mdanderson.org
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.97(2), pp.362-371
- DOI
- 10.1016/j.ijrobp.2016.10.041
- PMID
- 28011047
- NLM abbreviation
- Int J Radiat Oncol Biol Phys
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Publisher
- Elsevier Inc; United States
- Language
- English
- Date published
- 02/01/2017
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984047784102771
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