Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer Journal Article

Authors: Verma, V.; Simone, C. B., 2nd; Allen, P. K.; Gajjar, S. R.; Shah, C; Zhen, W.; Harkenrider, M. M.; Hallemeier, C. L.; Jabbour, S. K.; Matthiesen, C. L.; Braunstein, S. E.; Lee, P; Dilling, T. J.; Allen, B. G.; Nichols, E. M.; Attia, A.; Zeng, J.; Biswas, T.; Paximadis, P.; Wang, F; Walker, J. M.; Stahl, J. M.; Daly, M. E.; Decker, R. H.; Hales, R. K.; Willers, H.; Videtic, G. M.; Mehta, M. P.; Lin, S. H.
Article Title: Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer
Abstract: PURPOSE: 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. METHODS AND MATERIALS: 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. RESULTS: 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. CONCLUSIONS: 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.
Journal Title: International journal of radiation oncology, biology, physics
Volume: 97
Issue: 2
ISSN: 1879-355X; 0360-3016
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2017
Start Page: 362
End Page: 371
Language: eng
Notes: LR: 20170109; CI: Copyright (c) 2016; JID: 7603616; 2016/08/20 [received]; 2016/10/19 [revised]; 2016/10/26 [accepted]; ppublish