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Clinical Trial
. 2024 May 1;10(5):575-582.
doi: 10.1001/jamaoncol.2023.7269.

Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial

David A Palma  1 , Houda Bahig  2 , Andrew Hope  3 , Stephen Harrow  4 , Brock J Debenham  5 , Alexander V Louie  6 , Thi Trinh Thuc Toni Vu  2 , Edith Filion  2 , Andrea Bezjak  3 , Marie-Pierre Campeau  2 , Adele Duimering  5 , Meredith E Giuliani  3 , Joanna M Laba  1 , Pencilla Lang  1 , Benjamin H Lok  3 , X Melody Qu  1 , Srinivas Raman  3 , George B Rodrigues  1 , Christopher D Goodman  1 , Stewart Gaede  7 , Julie Morisset  8 , Andrew Warner  1 , Inderdeep Dhaliwal  9 , Christopher J Ryerson  10
Affiliations
Clinical Trial

Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial

David A Palma et al. JAMA Oncol. .

Abstract

Importance: Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options.

Objective: To prospectively assess the benefits and toxic effects of SABR in this patient population.

Design, setting, and participants: This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled.

Intervention: Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day.

Main outcomes and measures: The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted.

Results: Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration).

Conclusions and relevance: In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits.

Trial registration: ClinicalTrials.gov Identifier: NCT03485378.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Palma reported receiving grants from the London Health Sciences Foundation and Ontario Institute for Cancer Research during the conduct of the study, royalties from UpToDate Inc, and consultant fees from Need Inc outside the submitted work. Dr Bahig reported receiving a grant from Varian Medical Systems unrelated to the present work and receiving fees for serving on the AstraZeneca advisory board, unrelated to the current content. Dr Hope reported receiving personal fees from AstraZeneca Canada outside the submitted work. Dr Louie reported receiving fees for serving on the AstraZeneca advisory board and speaker’s bureau outside the submitted work. Dr Bezjak reported receiving personal fees from Astra Zeneca outside the submitted work. Dr Giuliani reported receiving fees for serving on the AstraZeneca and Bristol-Myers Squibb advisory boards outside the submitted work. Dr Lang reported receiving grants from Sequenom and London Health Sciences Foundation outside the submitted work. Dr Lok reported receiving grants from Pfizer and AstraZeneca, personal fees from AstraZeneca, and nonfinancial support from AstraZeneca outside the submitted work. Dr Qu reported receiving consultant fees from Need Inc outside the submitted work. Dr Goodman reported receiving personal fees from AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Flowchart
ILD indicates interstitial lung disease; SABR, stereotactic ablative radiotherapy.
Figure 2.
Figure 2.. Kaplan-Meier Plots for All 39 Patients Receiving Stereotactic Ablative Radiotherapy (SABR)
Figure 3.
Figure 3.. Changes in Quality of Life Over Time
FACT-L indicates Functional Assessment of Cancer Therapy: Lung. Error bars represent SEs.
See this image and copyright information in PMC

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References

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