Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non–small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location

• Published in: Clinical lung cancer 2019-01, Vol.20 (1), p.e63-e71
• Main Authors: Schonewolf, Caitlin A., Heskel, Marina, Doucette, Abigail, Singhal, Sunil, Frick, Melissa A., Xanthopoulos, Eric P., Corradetti, Michael N., Friedberg, Joseph S., Pechet, Taine T., Christodouleas, John P., Levin, William, Berman, Abigail, Cengel, Keith A., Verma, Vivek, Hahn, Stephen M., Kucharczuk, John C., Rengan, Ramesh, Simone, Charles B.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Dose Fractionation, Radiation; Female; Follow-Up Studies; Humans; Local control; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Middle Aged; Neoplasm Staging; NSCLC; Radiosurgery; SABR; SBRT; Stereotactic ablative radiotherapy; Survival Analysis; Treatment Outcome; Tumor Burden
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2018.09.004

Stereotactic body radiation therapy is standard for inoperable stage I non–small-cell lung cancer and an emerging surgical alternative in operable patients. Limited long-term data exist according to operability. Analysis of 186 patients (204 lesions) demonstrates stereotactic body radiation therapy is well-tolerated with excellent local control (LC) (5-year LC, 93.7%). Inoperable patients achieved similar LC and cancer-specific survival but worse overall survival, likely owing to comorbidities. Stereotactic body radiation therapy (SBRT) is standard for medically inoperable stage I non–small-cell lung cancer (NSCLC) and is emerging as a surgical alternative in operable patients. However, limited long-term outcomes data exist, particularly according to operability. We hypothesized long-term local control (LC) and cancer-specific survival (CSS) would not differ by fractionation schedule, tumor size or location, or operability status, but overall survival (OS) would be higher for operable patients. All consecutive patients with stage I (cT1-2aN0M0) NSCLC treated with SBRT from June 2009 to July 2013 were assessed. Thoracic surgeon evaluation determined operability. Local failure was defined as growth following initial tumor shrinkage or progression on consecutive scans. LC, CSS, and OS were calculated using Cox proportional hazards regression. A total of 186 patients (204 lesions) were analyzed. Most patients were inoperable (82%) with Eastern Cooperative Oncology Group performance status of 1 (59%) or 2 (26%). All lesions received biological effective doses ≥ 100 Gy most commonly (94%) in 3 to 5 fractions. The median follow-up was 4.0 years. LC at 2 and 5 years were 95.6% (95% confidence interval, 92%-99%) and 93.7% (95% confidence interval, 90%-98%), respectively. Compared with operable patients, inoperable patients did not have significant differences in 5-year LC (93.1% vs. 96.7%; P = .49), nodal failure (31.4% vs. 11.0%; P = .12), distant failure (12.2% vs. 10.4%; P = .98), or CSS (80.6% vs. 91.0%; P = .45) but trended towards worse OS (34.2% vs. 45.3%; P = .068). Tumor size, location, and fractionation did not significantly influence outcomes. SBRT has excellent, durable LC and CSS rates for early-stage NSCLC, although inoperable patients had somewhat lower OS than operable patients, likely owing to greater comorbidities.