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Clin Lung Cancer. 2018 Mar;19(2):e253-e261. doi: 10.1016/j.cllc.2017.11.001. Epub 2017 Nov 14.

Feasible Optimization of Stereotactic Ablative Radiotherapy Dose by Tumor Size for Stage I Non-small-cell Lung Cancer.

Author information

1
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: siyeol.song@gmail.com.
3
Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
4
Department of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
5
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Medical Health Science, Kangwon National University Graduate School, Chuncheon, Korea.
6
Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
7
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: ekchoi@amc.seoul.kr.

Abstract

INTRODUCTION:

The purpose of this study was to assess the effect of dose escalation of stereotactic ablative radiotherapy (SABR) by investigating the long-term clinical outcomes of SABR for stage I non-small-cell lung cancer (NSCLC).

METHODS:

A retrospective analysis was performed on a total of 169 patients with 178 lesions of stage I NSCLC treated with SABR at a single institution from June 2000 to May 2015. The standard dose scheme for SABR was 48 Gy in 4 fractions during the early period of the analysis, but it was escalated to 60 Gy in 4 fractions from June 2009. All failures were recorded over the follow-up period.

RESULTS:

Median follow-up time was 32 months. The 5-year overall survival rate was 46.7%, and the actuarial local control rate was 79.3%. Tumor size was an independent prognostic factor for survival. No relapse occurred in tumors ≤ 2 cm irrespective of SABR dose. Escalated doses of approximately 60 Gy in 4 fractions (biologically effective dose [BED] = 150 Gy10) achieved higher local control compared with 48 Gy in 4 fractions (BED = 106 Gy10) (76.2% vs. 60.6%) at 5-year follow-up (P = .022) in tumors > 2 cm. There were no differences in treatment-related toxicities between the dose groups. Major failures consisted of distant metastasis to another lung parenchyma.

CONCLUSION:

SABR provides satisfactory long-term local control and high overall survival in medically inoperable stage I NSCLC. Tumors ≤ 2 cm had no local recurrence regardless of dose; whereas for tumors > 2 cm, an escalated BED of approximately 150 Gy10 provided significantly higher local tumor control.

KEYWORDS:

Dose escalation; Local control; Non-small-cell lung cancer; Stage I; Stereotactic body radiotherapy

PMID:
29196082
DOI:
10.1016/j.cllc.2017.11.001
[Indexed for MEDLINE]

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