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. 2022 Aug 18;14(16):3993.
doi: 10.3390/cancers14163993.

Stereotactic Radiosurgery for Lung Cancer with a Risk-Adapted Strategy Using the Volumetric Modulated Arc Therapy Technique: A Single Arm Phase II Study

Takaya Yamamoto  1 , Yu Katagiri  1 , Yoko Tsukita  2 , Haruo Matsushita  1 , Rei Umezawa  1 , Yoshiyuki Katsuta  1 , Noriyuki Kadoya  1 , Noriyoshi Takahashi  1 , Yu Suzuki  1 , Kazuya Takeda  1 , Keita Kishida  1 , So Omata  1 , Eisaku Miyauchi  2 , Ryota Saito  2 , Keiichi Jingu  1
Affiliations

Stereotactic Radiosurgery for Lung Cancer with a Risk-Adapted Strategy Using the Volumetric Modulated Arc Therapy Technique: A Single Arm Phase II Study

Takaya Yamamoto et al. Cancers (Basel). .

Abstract

Purpose: A phase II study carried out to assess the efficacy of a risk-adapted strategy of stereotactic radiosurgery (SRS) for lung cancer. The primary endpoint was 3-year local recurrence, and the secondary endpoints were overall survival (OS), disease-free survival (DFS), rate of start of systemic therapy or best supportive care (SST-BSC), and toxicity.

Materials and methods: Eligible patients fulfilled the following criteria: performance status of 2 or less, forced expiratory volume in 1 s of 700 mL or more, and tumor not located in central or attached to the chest wall. Twenty-eight Gy was prescribed for primary lung cancers with diameters of 3 cm or less and 30 Gy was prescribed for primary lung cancers with diameters of 3.1-5.0 cm or solitary metastatic lung cancer diameters of 5 cm or less.

Results: Twenty-one patients were analyzed. The patients included 7 patients with adenocarcinoma, 2 patients with squamous cell carcinoma, 1 patient with metastasis, and 11 patients with clinical diagnosis. The median tumor diameter was 1.9 cm. SRS was prescribed at 28 Gy for 18 tumors and 30 Gy for 3 tumors. During the median follow-up period of 38.9 months for survivors, 1 patient had local recurrence, 7 patients had regional or distant metastasis, and 5 patients died. The 3-year local recurrence, SST-BSC, DFS, and OS rates were 5.3% (95% confidence interval [CI]: 0.3-22.2%), 20.1% (95% CI: 6.0-40.2%), 59.2% (95% CI: 34.4-77.3%), and 78.2% (95% CI: 51.4-91.3%), respectively. The 95% CI upper value of local recurrence was lower than the null local recurrence probability. There was no severe toxicity, and grade 2 radiation pneumonitis occurred in 1 patient.

Conclusions: Patients who received SRS for lung cancer had a low rate of 3-year local recurrence and tolerable toxicity.

Keywords: SRS; lung cancer; stereotactic body radiotherapy; stereotactic radiosurgery; volumetric modulated arc therapy.

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Conflict of interest statement

T.Y., Y.K. (Yu Katagiri), Y.T. and R.S. have received lecturer fees from AstraZeneca KK. E.M. has received grants from Chugai Pharmaceutical Co., Ltd. and Eli Lily Japan KK, honoraria from AstraZeneca KK, Taiho Pharmaceutical Co., Ltd., Daiichi Sankyo KK, Boehringer Ingelheim Japan Inc., Bristol Myers Squibb Co., Ltd., Novartis Pharma KK, MSD KK, Kyowa Kirin Co Ltd., Merck Biopharma Co., Ltd., Pfizer Inc., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., Otsuka pharmaceutical Co., Ltd. and Towa Pharmaceutical Co., Ltd., and EM has been advisory board of Chugai Pharmaceutical Co., Ltd., BoehringerIngelheim Japan Inc. and Eli Lilly Japan KK. K.J. has received consulting fees from Varian Medical Systems and Elekta, and honoraria from Shimazu. Co. H.M., R.U., Y.K. (Yoshiyuki Katsuta), N.K., N.T., Y.S., K.T., K.K. and S.O. have no conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence rates of local recurrence and percentage of patients who received systemic therapy or best supportive/palliative care (SST-BSC). The 1-year, 2-year and 3-year local recurrence rates were 0.0%, 0.0%, and 5.3%, respectively. The 1-year, 2-year, and 3-year SST-BSC rates were 4.8%, 14.8%, and 20.1%, respectively.
Figure 2
Figure 2
Kaplan–Meier curves of overall survival (OS) and disease-free survival (DFS). The 1-year, 2-year, and 3-year OS rates were 100.0%, 90.0%, and 78.2%, respectively. The 1-year, 2-year, and 3-year DFS rates were 85.7%%, 70.6%, and 59.2%, respectively.
Figure 3
Figure 3
(A) Curves of cumulative incidences of local recurrence after stereotactic radiosurgery (SRS) and after multi-fraction stereotactic body radiotherapy (SBRT) before propensity score matching. (B) Curves of cumulative incidences of percentage of patients who received systemic therapy or best supportive/palliative care (SST-BSC) after SRS and after multi-fraction SBRT before propensity score matching. (C) Curves of cumulative incidences of local recurrence after SRS and after multi-fraction SBRT after propensity score matching. (D) Curves of cumulative incidence of SST-BSC rate after SRS and after multi-fraction SBRT after propensity score matching.
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