Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer

Radiation Oncology

Stephen G Swisher²  Jack A Roth²  Reza J Mehran²  James Welsh³  Zhongxing Liao³  Ritsuko Komaki³  Peter Balter¹  Hui Liu³  Joe Y Chang³ 

[1] Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA

关键词: Predictive factors;    Toxicity;     F-fluorodeoxyglucose positron emission tomography;    Non-small cell lung cancer;    Stereotactic ablative radiotherapy;    Stereotactic body radiotherapy;   

Others  :  1155326
DOI  :  10.1186/1748-717X-7-152

 received in 2012-05-03, accepted in 2012-08-25,  发布年份 2012

【 摘 要 】

Background

Stereotactic ablative radiotherapy (SABR) can achieve excellent local control rates in early-stage non-small cell lung cancer (NSCLC) and has emerged as a standard treatment option for patients who cannot undergo surgery or those with isolated recurrences. However, factors that may predict toxicity or survival are largely unknown. We sought here to identify predictors of survival and pneumonitis after SABR for NSCLC in a relatively large single-institution series.

Methods

Subjects were 130 patients with stage I NSCLC treated with four-dimensional computed tomography (4D CT) –planned, on-board volumetric image–guided SABR to 50 Gy in 4 fractions. Disease was staged by positron emission tomography/computed tomography (PET/CT) and scans were obtained again at the second follow-up after SABR.

Results

At a median follow-up time of 26 months, the 2-year local control rate was 98.5%. The median overall survival (OS) time was 60 months, and OS rates were 93.0% at 1 year, 78.2% at 2 years, and 65.3% at 3 years. No patient experienced grade 4–5 toxicity; 15 had radiation pneumonitis (12 [9.3%] grade 2 and 3 [2.3%] grade 3). Performance status, standardized uptake value (SUV)_max on staging PET/CT, tumor histology, and disease operability were associated with OS on univariate analysis, but only staging SUV_max was independently predictive on multivariate analysis (P = 0.034). Dosimetric factors were associated with radiation pneumonitis on univariate analysis, but only mean ipsilateral lung dose ≥9.14 Gy was significant on multivariate analysis (P = 0.005).

Conclusions

OS and radiation pneumonitis after SABR for stage I NSCLC can be predicted by staging PET SUV_max and ipsilateral mean lung dose, respectively.

【 授权许可】

   
2012 Chang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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