Acute skin toxicity following stereotactic body radiation therapy for stage I non-small-cell lung cancer: who's at risk? Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Stereotactic body radiation therapy versus conventional radiation therapy in patients with early stage non-small cell lung cancer: An updated retrospective study on local failure and survival rates Dose-response for stereotactic body radiotherapy in early-stage non-small-cell lung cancer. Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer SPACE - A randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLC. The impact of tumor size on outcomes after stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer. Comparative effectiveness of 5 treatment strategies for early-stage non-small cell lung cancer in the elderly. Dose-volume parameters predict for the development of chest wall pain after stereotactic body radiation for lung cancer. Survival and quality of life after stereotactic or 3D-conformal radiotherapy for inoperable early-stage lung cancer. Stereotactic body radiation therapy for inoperable early stage lung cancer. Incidence and Risk Factors for Chest Wall Toxicity After Risk-Adapted Stereotactic Radiotherapy for Early-Stage Lung Cancer Stereotactic body radiotherapy using a radiobiology‐based regimen for stage I nonsmall cell lung cancer Lung Stereotactic Body Radiation Therapy: Regional Nodal Failure Is Not Predicted by Tumor Size
PURPOSE We examined the rate of acute skin toxicity within a prospect ively managed data base of patients treated for early-stage non-small-cell lung cancer ( NSCLC ) and investigated factors that might predict skin toxicity . METHODS From May 2006 through January 2008 , 50 patients with Stage I NSCLC were treated at Memorial Sloan-Kettering Cancer Center with 60 Gy in three fractions or 44 - 48 Gy in four fractions .  Patients were treated with multiple coplanar beams ( 3 - 7 , median 4 ) with a 6 MV linac using intensity-modulated radiotherapy ( IMRT ) and dynamic multileaf collimation .  Toxicity grading was performed and based on the National Cancer Institute Common Terminology Criteria for Adverse Effects . Factors associated with Grade 2 or higher acute skin reactions were calculated by Fisher 's exact test . RESULTS After a minimum 3 months of follow-up , 19 patients ( 38 % ) developed Grade 1 , 4 patients ( 8 % ) Grade 2 , 2 patients ( 4 % ) Grade 3 , and 1 patient Grade 4 acute skin toxicity . Factors associated with Grade 2 or higher acute skin toxicity included using only 3 beams ( p = 0.0007 ) , distance from the tumor to the posterior chest wall skin of less than 5 cm ( p = 0.006 ) , and a maximum skin dose of 50 % or higher of the prescribed dose ( p = 0.02 ) . CONCLUSIONS SBRT can be associated with significant skin toxicity . One must consider the skin dose when evaluating the treatment plan and consider the bolus effect of immobilization devices PURPOSE To present the results of stereotactic body radiotherapy ( SBRT ) for medically inoperable patients with Stage I non-small-cell lung cancer ( NSCLC ) and contrast outcomes in patients with and without a pathologic diagnosis . METHODS AND MATERIAL S Between December 2004 and October 2008 , 108 patients ( 114 tumors ) underwent treatment according to the prospect i ve research ethics board-approved SBRT protocol s at our cancer center . Of the 108 patients , 88 ( 81.5 % ) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography .  A pathologic diagnosis was unavailable for 33 ( 28.9 % ) of the 114 lesions . The SBRT schedules included 48 Gy in 4 fractions or 54 - 60 Gy in 3 fractions for peripheral lesions and 50 - 60 Gy in 8 - 10 fractions for central lesions . Toxicity and radiologic response were assessed at the 3 - 6-month follow-up visits using conventional criteria . RESULTS The mean tumor diameter was 2.4-cm ( range , 0.9 - 5.7 ) . The median follow-up was 19.1 months ( range , 1 - 55.7 ) . The estimated local control rate at 1 and 4 years was 92 % ( 95 % confidence interval [ CI ] , 86 - 97 % ) and 89 % ( 95 % CI , 81 - 96 % ) . The cause-specific survival rate at 1 and 4 years was 92 % ( 95 % CI , 87 - 98 % ) and 77 % ( 95 % CI , 64 - 89 % ) , respectively . No statistically significant difference was found in the local , regional , and distant control between patients with and without pathologically confirmed NSCLC . The most common acute toxicity was Grade 1 or 2 fatigue ( 53 of 108 patients ) . No toxicities of Grade 4 or greater were identified . CONCLUSIONS Lung SBRT for early-stage NSCLC result ed in excellent local control and cause-specific survival with minimal toxicity . The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis . SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC Abstract Introduction . Stereotactic body radiation therapy ( SBRT ) for early stage non-small cell lung cancer ( NSCLC ) is now an accepted and patient friendly treatment , but still controversy exists about its comparability to conventional radiation therapy ( RT ) . The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT . Material and methods . From August 2005 to June 2012 , 100 medically inoperable patients were treated with SBRT at Odense University Hospital . The thoracic RT consisted of 3 fractions ( F ) of 15–22 Gy delivered in nine days . For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35–40  F ( 5 F/week ) in the period of July 1998 to August 2011 were analyzed . All tumors had histological or cytological proven NSCLC T1 - 2N0M0 . Results . The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT , respectively ( p = 0.015 ) . Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 % , SBRT and conventional RT respectively ( p = 0.99 ) . On multivariate analysis , female gender and performance status of 0–1 and SBRT predicted improved prognosis . Conclusion . In a cohort of patients with NSCLC there was a significant difference in overall survival  favoring SBRT . Performance status of 0–1 , female gender and SBRT predicted improved prognosis . However , staging procedure , confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes . However , SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients PURPOSE To compare the efficacy of three lung stereotactic body radiotherapy ( SBRT ) regimens in a large institutional cohort . METHODS Between 2004 and 2009 , 130 patients underwent definitive lung cancer SBRT to a single lesion at the Mallinckrodt Institute of Radiology . We delivered 18 Gy × 3 fractions for peripheral tumors ( n = 111 ) and either 9 Gy × 5 fractions ( n = 8) or 10 Gy × 5 fractions ( n = 11 ) for tumors that were central or near critical structures . Univariate and multivariate analysis of prognostic factors was performed using the Cox proportional hazard model . RESULTS Median follow-up was 11 , 16 , and 13 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 groups , respectively . Local control statistics for Years 1 and 2 were , respectively , 75 % and 50 % for 9 Gy × 5 , 100 % and 100 % for 10 Gy × 5 , and 99 % and 91 % for 18 Gy × 3 . Median overall survival was 14 months , not reached , and 34 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 treatments , respectively . No difference in local control or overall survival was found between the 10 Gy × 5 and 18 Gy × 3 groups on log-rank test , but both groups had improved local control and overall survival compared with 9 Gy × 5 . Treatment with 9 Gy × 5 was the only independent prognostic factor for reduced local control on multivariate analysis , and increasing age , increasing tumor volume , and poor performance status predicted independently for reduced overall survival . CONCLUSION Treatment regimens of 10 Gy × 5 and 18 Gy × 3 seem to be efficacious for lung cancer SBRT and provide superior local control and overall survival compared with 9 Gy × 5 Background Stereotactic ablative radiotherapy ( SABR ) can achieve excellent local control rates in early-stage non-small cell lung cancer ( NSCLC ) and has emerged as a st and ard treatment option for patients who can not undergo surgery or those with isolated recurrences . However , factors that may predict toxicity or survival are largely unknown . We sought here to identify predictors of survival and pneumonitis after SABR for NSCLC in a relatively large single-institution series . Methods Subjects were 130 patients with stage I NSCLC treated with four-dimensional computed tomography ( 4D CT ) –planned , on-board volumetric image – guided SABR to 50 Gy in 4 fractions . Disease was staged by positron emission tomography/computed tomography ( PET/CT ) and scans were obtained again at the second follow-up after SABR . Results At a median follow-up time of 26 months , the 2-year local control rate was 98.5 % . The median overall survival ( OS ) time was 60 months , and OS rates were 93.0 % at 1 year , 78.2 % at 2 years , and 65.3 % at 3 years . No patient experienced grade 4–5 toxicity ; 15 had radiation pneumonitis ( 12 [ 9.3 % ] grade 2 and 3 [ 2.3 % ] grade 3 ) . Performance status , st and ardized uptake value (SUV)max on staging PET/CT , tumor histology , and disease operability were associated with OS on univariate analysis , but only staging SUVmax was independently predictive on multivariate analysis ( P = 0.034 ) . Dosimetric factors were associated with radiation pneumonitis on univariate analysis , but only mean ipsilateral lung dose ≥9.14 Gy was significant on multivariate analysis ( P = 0.005 ) . Conclusions OS and radiation pneumonitis after SABR for stage I NSCLC can be predicted by staging PET SUVmax and ipsilateral mean lung dose , respectively BACKGROUND Stereotactic body radiotherapy ( SBRT ) has been introduced for small lung tumors due to excellent local control and few side effects , even though there are no comparative studies . SPACE ( Stereotactic Precision And Conventional radiotherapy Evaluation ) is the first r and omized phase II trial comparing SBRT and conventional fractionated radiotherapy ( 3DCRT ) . METHODS Patients with stage I medically inoperable NSCLC were r and omized to receive SBRT to 66Gy in 3 fractions ( one week ) or 3DCRT to 70Gy ( 7weeks ) . Patients were followed to assess efficacy , toxicity and HRQL . FINDINGS Between 2007 and 2011 , 102 patients were r and omized . Mean age 74 ( 57 - 86 ) , 60 % women , the vast majority ( 92 % ) had COPD or cardiovascular comorbidity . The SBRT arm included more patients with T2-tumors ( p=0.02 ) and male gender ( p=0.35 ) . The median follow-up was 37months with a 1- , 2- and 3-year PFS of : SBRT : 76 % , 53 % , 42 % and 3DCRT : 87 % , 54 % 42 % , HR=0.85 ( 95 % CI 0.52 - 1.36 ) with no difference between the groups and no difference in OS ( HR=0.75 , 95 % CI 0.43 - 1.30 ) . At the end of the study 70 % of SBRT patients had not progressed compared to 59 % ( 3DCRT , p=0.26 ) . Toxicity was low with no grade 5 events . Pneumonitis of any grade was observed in 19 % ( SBRT ) and 34 % ( 3DCRT , p=0.26 ) , and esophagitis in 8 % and 30 % respectively ( p=0.006 ) . HRQL was evaluated with the EORTC QLQ 30 and LC14 module and patients treated with 3DCRT experienced worse dyspnea ( p=0.01 ) , chest pain ( p=0.02 ) and cough ( > 10 points difference ) . INTERPRETATION There was no difference in PFS and OS between SBRT and conventionally treated patients despite an imbalance of prognostic factors . We observed a tendency of an improved disease control rate in the SBRT group and they experienced better HRQL and less toxicity .  SBRT is convenient for patients and should be considered st and ard treatment for patients with inoperable stage I NSCLC PURPOSE Stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer ( NSCLC ) offers excellent control rates . Most published series deal mainly with small ( usually < 4 cm ) , peripheral , solitary tumors . Larger tumors are associated with poorer outcomes ( ie , lower control rates , higher toxicity ) when treated with conventional RT . It is unclear whether SBRT is sufficiently potent to control these larger tumors . We therefore evaluated and examined the influence of tumor size on treatment outcomes after SBRT . METHODS AND MATERIAL S Between October 2004 and October 2010 , 185 medically inoperable patients with early ( T1-T2N0M0 ) NSCLC were treated on a prospect i ve research ethics board-approved single-institution protocol . Prescription doses were risk-adapted based on tumor size and location . Follow-up included prospect i ve assessment of toxicity ( as per Common Terminology Criteria for Adverse Events , version 3.0 ) and serial computed tomography scans . Patterns of failure , toxicity , and survival outcomes were calculated using Kaplan-Meier method , and the significance of tumor size ( diameter , volume ) with respect to patient , treatment , and tumor factors was tested . RESULTS Median follow-up was 15.2 months . Tumor size was not associated with local failure but was associated with regional failure ( P=.011 ) and distant failure ( P=.021 ) . Poorer overall survival ( P=.001 ) , disease-free survival ( P=.001 ) , and cause-specific survival ( P=.005 ) were also significantly associated with tumor size ( with tumor volume more significant than diameter ) . Gross tumor volume and planning target volume were significantly associated with grade 2 or worse radiation pneumonitis . However , overall rates of grade ≥3 pneumonitis were low and not significantly affected by tumor or target size . CONCLUSIONS Currently employed stereotactic body radiation therapy dose regimens can provide safe effective local therapy even for larger solitary NSCLC tumors ( up to 5.7 cm in tumor diameter or 100 cm(3 ) in tumor volume ) but are associated with more nonlocal failures as well as poorer survival . These observations suggest these patients may benefit from more extensive staging or consideration of adjuvant therapy PURPOSE The incidence of early-stage non-small cell lung cancer ( NSCLC ) among older adults is expected to increase because of demographic trends and computed tomography-based screening ; yet , optimal treatment in the elderly remains controversial . Using the Surveillance , Epidemiology , and End Results (SEER)-Medicare cohort spanning 2001 - 2007 , we compared survival outcomes associated with 5 strategies used in contemporary practice : lobectomy , sublobar resection , conventional radiation therapy , stereotactic ablative radiation therapy ( SABR ) , and observation . METHODS AND MATERIAL S Treatment strategy and covariates were determined in 10,923 patients aged ≥ 66 years with stage IA-IB NSCLC . Cox regression , adjusted for patient and tumor factors , compared overall and disease-specific survival for the 5 strategies . In a second exploratory analysis , propensity-score matching was used for comparison of SABR with other options . RESULTS The median age was 75 years , and 29 % had moderate to severe comorbidities . Treatment distribution was lobectomy ( 59 % ) , sublobar resection ( 11.7 % ) , conventional radiation ( 14.8 % ) , observation ( 12.6 % ) , and SABR ( 1.1 % ) . In Cox regression analysis with a median follow-up time of 3.2 years , SABR was associated with the lowest risk of death within 6 months of diagnosis ( hazard ratio [ HR ] 0.48 ; 95 % confidence interval [ CI ] 0.38 - 0.63 ; referent is lobectomy ) . After 6 months , lobectomy was associated with the best overall and disease-specific survival . In the propensity-score matched analysis , survival after SABR was similar to that after lobectomy ( HR 0.71 ; 95 % CI 0.45 - 1.12 ; referent is SABR ) . Conventional radiation and observation were associated with poor outcomes in all analyses . CONCLUSIONS In this population -based experience , lobectomy was associated with the best long-term outcomes in fit elderly patients with early-stage NSCLC . Exploratory analysis of SABR early adopters suggests efficacy comparable with that of surgery in select population s. Evaluation of these therapies in r and omized trials is urgently needed PURPOSE Chest wall ( CW ) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy ( SBRT ) for non-small-cell lung cancer ( NSCLC ) . We developed a dose-volume model to predict the development of this toxicity . METHODS AND MATERIAL S A total of 126 patients with primary , clinical ly node-negative NSCLC received three to five fractions of SBRT to doses of 40 - 60 Gy and were prospect ively followed . The dose-absolute volume histograms of two different definitions of the CW as an organ at risk ( CW3 cm and CW2 cm ) were examined for all 126 patients . RESULTS With a median follow-up of 16 months , the 2-year estimated actuarial incidence of Grade ≥ 2 CW pain was 39 % . The median time to onset of Grade ≥ 2 CW pain ( National Cancer Institute Common Terminology Criteria for Adverse Events , Version 3.0 ) was 9 months . There was no predictive advantage for biologically corrected dose over physical dose . Neither fraction number ( p = 0.07 ) nor prescription dose ( p = 0.07 ) were significantly correlated with the development of Grade ≥ 2 CW pain . Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations , with the CW volume receiving 30 Gy ( V30 ) as one of the strongest predictors ( p < 0.001 ) . CW2 cm consistently enabled better prediction of CW toxicity . When a physical dose of 30 Gy was received by more than 70 cm(3 ) of CW2 cm , there was a significant correlation with Grade ≥ 2 CW pain ( p = 0.004 ) . CONCLUSIONS CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients . A volume of CW ≥ 70 cm(3 ) receiving 30 Gy is significantly correlated with Grade ≥ 2 CW pain . We are currently applying this constraint at our institution for patients receiving thoracic SBRT . An actuarial atlas of our data is provided as an electronic supplement to facilitate data -sharing and meta- analysis relating to CW pain PURPOSE To investigate survival and local recurrence after stereotactic ablative radiotherapy ( SABR ) or three-dimensional conformal radiotherapy ( 3D-CRT ) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life ( HRQOL ) parameters after either treatment . METHODS AND MATERIAL S Two prospect i ve cohorts of inoperable patients with T1 - 2N0M0 primary lung tumors were analyzed . Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR .  Global quality of life ( GQOL ) , physical functioning ( PF ) , and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Question naire-C30 and LC13 . HRQOL was analyzed using multivariate linear mixed-effects modeling , survival and local control ( LC ) using the Kaplan-Meier method , Cox proportional hazards analysis , and Fine and Gray multivariate competing risk analysis as appropriate . RESULTS Overall survival ( OS ) was better after SABR compared with 3D-CRT with a HR of 2.6 ( 95 % confidence interval [ CI ] : 1.5 - 4.8 ; p < 0.01 ) . 3D-CRT conferred a subhazard ratio for LC of 5.0 ( 95 % CI : 1.7 - 14.7 ; p < 0.01 ) compared with SABR . GQOL and PF were stable after SABR ( p = 0.21 and p = 0.62 , respectively ) . Dyspnea increased after SABR by 3.2 out of 100 points ( 95 % CI : 1.0 - 5.3 ; p < 0.01 ) , which is clinical ly insignificant . At 1 year , PF decreased by an excess of 8.7 out of 100 points ( 95 % CI : 2.8 - 14.7 ; p < 0.01 ) after 3D-CRT compared with SABR . CONCLUSION In this nonr and omized comparison of two prospect i ve cohorts of medically inoperable patients with Stage I lung cancer , OS and LC were better after SABR . GQOL , PF , and patient-rated dyspnea were stable after SABR , whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year CONTEXT Patients with early stage but medically inoperable lung cancer have a poor rate of primary tumor control ( 30%-40 % ) and a high rate of mortality ( 3-year survival , 20%-35 % ) with current management . OBJECTIVE To evaluate the toxicity and efficacy of stereotactic body radiation therapy in a high-risk population of patients with early stage but medically inoperable lung cancer . DESIGN , SETTING , AND PATIENTS Phase 2 North American multicenter study of patients aged 18 years or older with biopsy-proven peripheral T1-T2N0M0 non-small cell tumors ( measuring < 5 cm in diameter ) and medical conditions precluding surgical treatment . The prescription dose was 18 Gy per fraction x 3 fractions ( 54 Gy total ) with entire treatment lasting between 1(1/2 ) and 2 weeks . The study opened May 26 , 2004 , and closed October 13 , 2006 ; data were analyzed through August 31 , 2009 . MAIN OUTCOME MEASURES The primary end point was 2-year actuarial primary tumor control ; secondary end points were disease-free survival ( ie , primary tumor , involved lobe , regional , and disseminated recurrence ) , treatment-related toxicity , and overall survival . RESULTS A total of 59 patients accrued , of which 55 were evaluable ( 44 patients with T1 tumors and 11 patients with T2 tumors ) with a median follow-up of 34.4 months ( range , 4.8 - 49.9 months ) . Only 1 patient had a primary tumor failure ; the estimated 3-year primary tumor control rate was 97.6 % ( 95 % confidence interval [ CI ] , 84.3%-99.7 % ) . Three patients had recurrence within the involved lobe ; the 3-year primary tumor and involved lobe ( local ) control rate was 90.6 % ( 95 % CI , 76.0%-96.5 % ) . Two patients experienced regional failure ; the local-regional control rate was 87.2 % ( 95 % CI , 71.0%-94.7 % ) . Eleven patients experienced disseminated recurrence ; the 3-year rate of disseminated failure was 22.1 % ( 95 % CI , 12.3%-37.8 % ) . The rates for disease-free survival and overall survival at 3 years were 48.3 % ( 95 % CI , 34.4%-60.8 % ) and 55.8 % ( 95 % CI , 41.6%-67.9 % ) , respectively . The median overall survival was 48.1 months ( 95 % CI , 29.6 months to not reached ) . Protocol -specified treatment-related grade 3 adverse events were reported in 7 patients ( 12.7 % ; 95 % CI , 9.6%-15.8 % ) ; grade 4 adverse events were reported in 2 patients ( 3.6 % ; 95 % CI , 2.7%-4.5 % ) . No grade 5 adverse events were reported . CONCLUSION Patients with inoperable non-small cell lung cancer who received stereotactic body radiation therapy had a survival rate of 55.8 % at 3 years , high rates of local tumor control , and moderate treatment-related morbidity Introduction : High local control rates are reported after stereotactic ablative body radiotherapy ( SABR ) in stage I non-small cell lung cancer . Toxicity is uncommon , but few reports on long-term follow-up are available . We studied the incidence of chest wall pain ( CWP ) and rib fractures in patients with long-term follow-up . Methods : Between 2003 and 2009 , 500 patients ( 530 tumors ) underwent SABR using risk-adapted fractionation schemes , consisting of three fractions of 20 Gy , five fractions of 12 Gy , or eight fractions of 7.5 Gy .  Toxicity data were collected in a prospect i ve data base and scored using Common Terminology Criteria for Adverse Events ( CTCAE ) version 4.03 . Chest wall volumes receiving doses of 30 , 40 , 45 , and 50 Gy ( V30 Gy-V50 Gy ) and maximum dose in 2 cm3 of chest wall ( D2 ml ) were determined for patients with CWP or rib fractures ( n = 57 ) . Results : With a median follow-up of 33 months , the 3-year overall survival and local control rates were 53.1 % and 90.4 % , respectively . CWP developed in 11.4 % of patients and was severe ( grade 3 ) in 2.0 % . Rib fractures were observed in eight patients ( 1.6 % ) , accompanied by CWP in seven of these patients . On multivariate analysis , patients with CWP had larger treatment volumes and shorter tumor-chest wall distances , whereas patients with rib fractures had larger tumor diameters and treatment volumes . Grade 3 CWP and rib fractures were associated with larger volumes of chest wall receiving doses of 30 to 50 Gy and rib fractures specifically with a higher maximum dose in the chest wall . Conclusions : Severe ( grade 3 ) chest wall toxicity is uncommon after risk-adapted SABR and manifests in 2 % or fewer of patients The most common regimen of stereotactic body radiotherapy ( SBRT ) for stage I nonsmall cell lung cancer in Japan is 48 grays ( Gy ) in 4 fractions over 4 days . Radiobiologically , however , higher doses are necessary to control larger tumors , and interfraction intervals should be > 24 hours to take advantage of reoxygenation . In this study , the authors tested the following regimen : For tumors that measured < 1.5 cm , 1.5 to 3.0 cm , and > 3.0 cm in greatest dimension , radiation doses of 44 Gy , 48 Gy , and 52 Gy , respectively , were given in 4 fractions with interfraction intervals of ≥3 days Introduction : To examine regional nodal failure patterns with respect to lesion size in medically inoperable early-stage non – small cell lung cancer ( NSCLC ) patients treated with definitive lung stereotactic body radiation therapy ( SBRT ) .  Methods : Between 2004 and 2012 , 342 medically inoperable early-stage NSCLC patients treated with definitive SBRT were identified in our institutional review board – approved prospect i ve registry . All patients were treated on a Novalis/BrainLAB system using ExacTrac for image guidance . Kaplan – Meier analysis was performed with the log-rank test used to detect differences between lesion size and nodal failure patterns . Cox-proportional hazard regression analysis was performed to identify predictors of nodal failure . Results : Median follow-up was 17.6 months ( range , 0–84 months ) . Median tumor size , positron emission tomography maximum st and ardized uptake value , and dose/fractionation were 2.2 cm ( range , 0.8–7.2 cm ) , 6.7 ( range , 1–59 ) , and 50 Gray (Gy)/five fractions , respectively . Of the 342 lesions evaluated , 14.6 % ( 50 of 342 ) experienced nodal failure . Nodal failure rates were 17.45 % ( 26 of 149 ) , 10.3 % ( 11 of 107 ) , 14.1 % ( 10 of 71 ) , and 20 % ( 3 of 15 ) for lesions less than or equal to 2 cm , 2.1 to 3 cm , 3.1 to 5 cm , and greater than 5 cm , respectively . Rates of nodal failure were not significantly different between the four different size groups ( p = 0.15 ) . On univariate analysis , 2.1 to 3 cm lesions versus less than or equal to 2 cm exhibited less nodal failure after SBRT ( hazard ratio = 0.406 ; 95 % confidence interval = 0.189–0.87 ; p = 0.0205 ) . No other patient , tumor , or treatment factor significantly affected nodal failure . Conclusion : For early-stage NSCLC treated with SBRT , tumor size does not influence the rates of regional nodal failure . This finding warrants further investigation on the possible mechanisms of SBRT by which loco-regional control is improved
Abstract Patients with early‐stage non – small‐cell lung cancer ( NSCLC ) who are unable to undergo surgery can be offered radiation therapy ( RT ) .
Previously , conventional RT was offered ; however , newer techniques such as stereotactic body RT ( SBRT ) have become available .
The objective of the present systematic review was to investigate the effectiveness of RT with curative intent in patients with early‐stage medically inoperable NSCLC .