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. 2013 Jul 10:8:179.
doi: 10.1186/1748-717X-8-179.

Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer

Sana D Karam, Zachary D Horne, Robert L Hong, Don McRae, David Duhamel, Nadim M Nasr

Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer

Sana D Karam et al. Radiat Oncol. .

Abstract

Introduction: Low survival outcomes have been reported for the treatment of locally advanced non small cell lung cancer (LA-NSCLC) with the standard of care treatment of concurrent chemoradiation (cCRT). We present our experience of dose escalation using stereotactic body radiosurgery (SBRT) following conventional cCRT for patients with LA-NSCLC.

Methods: Sixteen patients with a median age of 67.5 treated with fractionated SBRT from 2010 to 2012 were retrospectively analyzed. Nine (56%) of the patients had stage IIIB, 6 (38%) has stage IIIA, and 1 (6%) had recurrent disease. Majority of the patients (63%) presented with N2 disease. All patients had a PET CT for treatment planning. Patients received conventional cCRT to a median dose of 50.40 Gy (range 45-60) followed by an SBRT boost with an average dose of 25 Gy (range 20-30) given over 5 fractions.

Results: With a median follow-up of 14 months (range, 1-14 months), 1-year overall survival (OS), progression free survival (PFS), local control (LC), regional control (RC), and distant control (DC) rates were, 78%, 42%, 76%, 79%, and 71%, respectively. Median times to disease progression and regional failure were 10 months and 18 months, respectively. On univariate analysis, advanced age and nodal status were worse prognostic factors of PFS (p < 0.05). Four patients developed radiation pneumonitis and one developed hemoptysis. Treatment was interrupted in one patient who required hospitalization due to arrhythmias and pneumonia.

Conclusion: Risk adaptive dose escalation with SBRT following external beam radiotherapy is possible and generally tolerated treatment option for patients with LA-NSCLC.

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Figures

Figure 1
Figure 1
Survival outcomes. A. Local control. B. Regional Control. C. Progression Free Survival. D. Overall Survival.
Figure 2
Figure 2
Progression free survival by nodal status.
See this image and copyright information in PMC

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