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Radiother Oncol. 2010 Jan;94(1):1-11. doi: 10.1016/j.radonc.2009.12.008. Epub 2010 Jan 13.

Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications.

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  • 1Department of Radiation Oncology, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85724, USA. achiaz2010@gmail.com

Abstract

PURPOSE:

To analyze the patterns of failure, the toxicity profile, and the factors influencing efficacy of stereotactic body radiation (SBRT) for early-stage non-small-cell lung cancer (NSCLC).

METHODS AND MATERIALS:

A search was based on PubMed electronic databases. All searches were conducted in May, 2009.

RESULTS:

The local control ranged from 80% to 100% in most studies with adequate isocentric or peripheral biologically effective dose (BED). Recurrences were associated with increased tumor size. The main pattern of failure after SBRT was distant metastasis. Grades 3-5 toxicity occurred mostly in centrally located tumors, and adjuvant chemotherapy may further decrease all recurrences; possibly translating to a survival benefit in large or centrally located tumors where high BED cannot be safely reached.

CONCLUSION:

SBRT is an excellent treatment option for early-stage, and mostly medically inoperable, NSCLC. BED at both the isocenter and the tumor periphery is very important for optimal tumor control; higher doses are required for large (T2) lesions; SBRT for centrally located tumors can be feasible with a much less aggressive dose regimen than 60-66Gy/3 fractions and adjacent critical structures excluded from the target volume; chemotherapy may optimize the clinical outcome in large or centrally located lesions.

Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

PMID:
20074823
[PubMed - indexed for MEDLINE]
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