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Cancer. 2017 Feb 15;123(4):688-696. doi: 10.1002/cncr.30375. Epub 2016 Oct 14.

Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non-small cell lung tumors.

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Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky.
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Department of Radiation Oncology, University of California at San Francisco, San Francisco, California.
Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon.
Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois.
Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida.
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Radiation Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.



Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non-small cell lung cancer (NSCLC) measuring < 5 cm, but its use among patients with tumors measuring ≥5 cm is considerably less defined, with the existing literature limited to small, single-institution reports. The current multi-institutional study reported outcomes evaluating the largest such population reported to date.


Clinical/treatment characteristics, outcomes, toxicities, and patterns of failure were assessed in patients with primary NSCLC measuring ≥5 cm without evidence of distant/lymph node metastasis who underwent SBRT using ≤5 fractions. Statistics included Kaplan-Meier survival analyses and univariate/multivariate Cox proportional hazards models.


A total of 92 patients treated from 2004 through 2016 were analyzed from 12 institutions. The median follow-up was 12 months (15 months in survivors). The median age and tumor size among the patients were 73 years (range, 50-95 years) and 5.4 cm (range, 5.0-7.5 cm), respectively. The median dose/fractionation was 50 Gray/5 fractions. The actuarial local control rates at 1 year and 2 years were 95.7% and 73.2%, respectively. The disease-free survival rate was 72.1% and 53.5%, respectively, at 1 year and 2 years. The 1-year and 2-year disease-specific survival rates were 95.5% and 78.6%, respectively. The median, 1-year, and 2-year overall survival rates were 21.4 months, 76.2%, and 46.4%, respectively. On multivariate analysis, lung cancer history and pre-SBRT positron emission tomography maximum standardized uptake value were found to be associated with overall survival. Posttreatment failures were most commonly distant (33% of all disease recurrences), followed by local (26%) and those occurring elsewhere in the lung (23%). Three patients had isolated local failures. Grade 3 to 4 toxicities included 1 case (1%) and 4 cases (4%) of grade 3 dermatitis and radiation pneumonitis, respectively (toxicities were graded according to the Common Terminology Criteria for Adverse Events [version 4.0]). Grades 2 to 5 radiation pneumonitis occurred in 11% of patients. One patient with a tumor measuring 7.5 cm and a smoking history of 150 pack-years died of radiation pneumonitis.


The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688-696. © 2016 American Cancer Society.


chemotherapy; image-guided radiotherapy; non-small cell lung cancer; stereotactic body radiotherapy; toxicity

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