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Clinical Trial
. 2012 Sep 10:7:152.
doi: 10.1186/1748-717X-7-152.

Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer

Joe Y Chang  1 , Hui Liu, Peter Balter, Ritsuko Komaki, Zhongxing Liao, James Welsh, Reza J Mehran, Jack A Roth, Stephen G Swisher
Affiliations
Clinical Trial

Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer

Joe Y Chang et al. Radiat Oncol. .

Abstract

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 standard treatment option for patients who cannot 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, standardized uptake value (SUV)max on staging PET/CT, tumor histology, and disease operability were associated with OS on univariate analysis, but only staging SUV(max) 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 SUV(max) and ipsilateral mean lung dose, respectively.

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Figures

Figure 1
Figure 1
Overall survival (OS) and progression-free survival (PFS) for 130 patients treated with stereotactic ablative radiotherapy (SABR) for stage I NSCLC.
Figure 2
Figure 2
Overall survival according to maximum standardized uptake value (SUVmax) on staging PET/CT scans.
See this image and copyright information in PMC

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