Lung stereotactic body radiation therapy (SBRT) delivered over 4 or 11 days: A comparison of acute toxicity and quality of life

• Published in: Radiotherapy and oncology 2013-08, Vol.108 (2), p.320-325
• Main Authors: Jain, Suneil, Poon, Ian, Soliman, Hany, Keller, Brian, Kim, Anthony, Lochray, Fiona, Yeung, Latifa, Cheung, Patrick
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Disease-Free Survival; Dose Fractionation; Dose-Response Relationship, Radiation; Female; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Pilot Projects; Postoperative Complications - epidemiology; Postoperative Complications - pathology; Postoperative Complications - physiopathology; Quality of Life; Radiation Dosage; Radiation Injuries - epidemiology; Radiation Injuries - pathology; Radiation Injuries - physiopathology; Radiosurgery - adverse effects; Radiosurgery - methods; Risk Assessment; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2013.06.045

Abstract Purpose The optimal duration over which lung SBRT should be delivered is unknown. We conducted a randomized pilot study in patients treated with four fractions of lung SBRT delivered over 4 or over 11 days. Methods Patients with a peripheral solitary lung tumor (NSCLC or pulmonary metastasis) ⩽5 cm were eligible. For NSCLC lung tumors ⩽3 cm, a dose of 48 Gy in 4 fractions was used, otherwise 52 Gy in 4 fractions was delivered. Patients were randomized to receive treatment over 4 consecutive days or over 11 days. The primary end-point was acute grade ⩾2 toxicity. Secondary end-points included quality of life (QOL) assessed using the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Results Fifty four patients were enrolled. More patients in the 11 day group had respiratory symptoms at baseline. 55.6% patients treated over 4 days and 33.3% of patients treated over 11 days experienced acute grade ⩾2 toxicity ( p = 0.085). Dyspnea, fatigue and coughing domains were worse in the 11 day group at baseline. At 1 and 4 months, more patients in the 4 day group experienced a clinically meaningful worsening in the dyspnea QOL domain compared to the 11 day group (44.5% vs 15.4%, p = 0.02; 38.5% vs 12.0%, p = 0.03, respectively). However, raw QOL scores were not different at these time-points between treatment groups. Conclusions Grade 2 or higher acute toxicity was more common in the 4 day group, approaching statistical significance. More patients treated on 4 consecutive days reported a clinically meaningful increase in dyspnea, although interpretation of these results is challenging due to baseline imbalance between treatment groups. Larger studies are required to validate these results.