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Volume 68, Issue 1, Pages 72-77 (April 2010)


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Stereotactic body radiation therapy for early stage non-small cell lung cancer: Results of a prospective trial

Umberto RicardiaCorresponding Author Informationemail address, Andrea Riccardo Filippia, Alessia Guarneria, Francesca Romana Gigliolib, Patrizia Ciammellaa, Pierfrancesco Francoa, Cristina Mantovania, Piero Borasioc, Giorgio Vittorio Scagliottid, Riccardo Ragonaa

Received 13 March 2009; received in revised form 14 May 2009; accepted 16 May 2009. published online 25 June 2009.

Abstract 

Patients affected with early stage (IA–IB) non-small cell lung cancer (NSCLC), deemed medically inoperable, are usually treated by conventional 3D-CRT, with poor results in terms of local tumour control and survival. Hypofractionated stereotactic body radiation therapy (SBRT) appears to be a valid alternative option, with high rates of local control and promising survival rates according to recent reported series. We herein report the final results of a prospective phase II trial of SBRT in 62 stage I NSCLC patients, homogeneously treated with three fractions of 15Gy each, given every other day during a 1 week time, up to a total dose of 45Gy; dose was prescribed to the 80%-isodose encompassing planning target volume. Patients were immobilized in a dedicated stereotactic body frame; margins around gross tumour volume were 5mm in the axial plane and 10mm in the longitudinal direction. Median age was 73.7 years. A pathologic confirmation of NSCLC was obtained in 64.5% of patients. Forty-three patients had stage IA and 19 stage IB disease. The majority of patients did not experience any toxicity; mild skin reactions, fatigue, dyspnea/cough or transient thoracic pain were recorded in approximately 10% of patients. With a median follow-up time of 28 months, 2 patients experienced an isolated local relapse, 4 an isolated nodal relapse and 15 a systemic failure. At 3 years, local control rate was 87.8%, cancer-specific survival 72.5%, overall survival 57.1%, with 8 out of 20 non-cancer related deaths. In multivariate analysis, tumour volume was associated with a better outcome. In our series, SBRT was well tolerated and confirmed its efficacy, with local control and survival rates globally superior to those reported using conventional radiotherapy. A longer follow-up is needed in order to establish a correct comparison with surgical series, and to fully ascertain a potential negative impact of SBRT on comorbidities of such a fragile patients population.

a Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, S. Giovanni Battista Hospital, Via Genova, 3, 10126 Torino, Italy

b Medical Physics, S. Giovanni Battista Hospital, Torino, Italy

c Department of Clinical and Biological Sciences, Thoracic Surgery Unit, University of Torino, S. Luigi Hospital, Orbassano, Italy

d Department of Clinical and Biological Sciences, Thoracic Oncology Unit, University of Torino, S. Luigi Hospital, Orbassano, Italy

Corresponding Author InformationCorresponding author. Tel.: +39 0116705350; fax: +39 0116638680.

PII: S0169-5002(09)00310-9

doi:10.1016/j.lungcan.2009.05.007


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