Long-term Clinical Outcomes and Safety Profile of SBRT for Centrally Located NSCLC

Andrea L.H. Arnett, Benjamin Mou, Dawn Owen, Sean S Park, Katy Nelson, Christopher Hallemeier, Terence Sio, Yolanda Isabel Garces, Kenneth R. Olivier, Kenneth W. Merrell

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Previous studies suggest that stereotactic body radiation therapy (SBRT) is associated with higher toxicity rates for central lung tumors relative to peripheral tumors when using 3 fraction SBRT. The initial results from Radiation Therapy Oncology Group study 0813 suggest a safe toxicity profile of SBRT administered in 5 fractions for central non-small cell lung cancer (NSCLC). We reviewed our institutional data to evaluate the safety and efficacy of SBRT for central NSCLC. Methods and materials: We reviewed our prospectively collected SBRT database for patients with central NSCLC who received SBRT between 2008 and 2014. The most frequent dose and fractionations were 50 Gy in 5 fractions (59%) and 48 Gy in 4 fraction (30%). Local control (LC), regional control, metastasis-free survival, and overall survival were calculated using Kaplan-Meier estimates. The National Cancer Institute Common Terminal Criteria for Adverse Events were used for toxicity grading. Results: A total of 110 central lung tumors in 103 patients were included. The median age was 74 years (range, 40-95 years), and the median follow-up time of living patients was 50 months. The mean tumor size was 20 mm (range, 5-70 mm). The 5 year rate of LC, regional control, and distant control was 89%, 77%, and 82%, respectively. The median and 5-year overall survival were 3.5 years and 35%, respectively. No treatment variables were associated with tumor control or other clinical outcomes. A single patient experienced grade 3 radiation pneumonitis (0.97%). The rate of late toxicity grade ≥3 was 9.7% (grade 3, 7.7%; grade 4, 0.97%; grade 5, 0.97%) and included pneumonitis (3.9%), bronchial necrosis (2.9%), myocardial dysfunction (1.9%), and worsening heart failure (0.97%). Conclusions: SBRT for central NSCLC provides high rates of LC. Despite excellent LC, patients remain at risk for regional and distant failure. The rate of grade 3 pneumonitis was consistent with that of prior reports. We observed low rates of grade 4-5 toxicity potentially attributable to SBRT. Our results contribute to the growing body of data in support of the safety of SBRT for central NSCLC.

Original languageEnglish (US)
JournalAdvances in Radiation Oncology
DOIs
StatePublished - Jan 1 2019

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Non-Small Cell Lung Carcinoma
Radiotherapy
Safety
Neoplasms
Survival
Pneumonia
Dose Fractionation
Radiation Pneumonitis
Lung
Radiation Oncology
National Cancer Institute (U.S.)
Kaplan-Meier Estimate
Necrosis
Heart Failure
Databases
Neoplasm Metastasis

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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Long-term Clinical Outcomes and Safety Profile of SBRT for Centrally Located NSCLC. / Arnett, Andrea L.H.; Mou, Benjamin; Owen, Dawn; Park, Sean S; Nelson, Katy; Hallemeier, Christopher; Sio, Terence; Garces, Yolanda Isabel; Olivier, Kenneth R.; Merrell, Kenneth W.

In: Advances in Radiation Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Arnett, Andrea L.H. ; Mou, Benjamin ; Owen, Dawn ; Park, Sean S ; Nelson, Katy ; Hallemeier, Christopher ; Sio, Terence ; Garces, Yolanda Isabel ; Olivier, Kenneth R. ; Merrell, Kenneth W. / Long-term Clinical Outcomes and Safety Profile of SBRT for Centrally Located NSCLC. In: Advances in Radiation Oncology. 2019.
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abstract = "Purpose: Previous studies suggest that stereotactic body radiation therapy (SBRT) is associated with higher toxicity rates for central lung tumors relative to peripheral tumors when using 3 fraction SBRT. The initial results from Radiation Therapy Oncology Group study 0813 suggest a safe toxicity profile of SBRT administered in 5 fractions for central non-small cell lung cancer (NSCLC). We reviewed our institutional data to evaluate the safety and efficacy of SBRT for central NSCLC. Methods and materials: We reviewed our prospectively collected SBRT database for patients with central NSCLC who received SBRT between 2008 and 2014. The most frequent dose and fractionations were 50 Gy in 5 fractions (59{\%}) and 48 Gy in 4 fraction (30{\%}). Local control (LC), regional control, metastasis-free survival, and overall survival were calculated using Kaplan-Meier estimates. The National Cancer Institute Common Terminal Criteria for Adverse Events were used for toxicity grading. Results: A total of 110 central lung tumors in 103 patients were included. The median age was 74 years (range, 40-95 years), and the median follow-up time of living patients was 50 months. The mean tumor size was 20 mm (range, 5-70 mm). The 5 year rate of LC, regional control, and distant control was 89{\%}, 77{\%}, and 82{\%}, respectively. The median and 5-year overall survival were 3.5 years and 35{\%}, respectively. No treatment variables were associated with tumor control or other clinical outcomes. A single patient experienced grade 3 radiation pneumonitis (0.97{\%}). The rate of late toxicity grade ≥3 was 9.7{\%} (grade 3, 7.7{\%}; grade 4, 0.97{\%}; grade 5, 0.97{\%}) and included pneumonitis (3.9{\%}), bronchial necrosis (2.9{\%}), myocardial dysfunction (1.9{\%}), and worsening heart failure (0.97{\%}). Conclusions: SBRT for central NSCLC provides high rates of LC. Despite excellent LC, patients remain at risk for regional and distant failure. The rate of grade 3 pneumonitis was consistent with that of prior reports. We observed low rates of grade 4-5 toxicity potentially attributable to SBRT. Our results contribute to the growing body of data in support of the safety of SBRT for central NSCLC.",
author = "Arnett, {Andrea L.H.} and Benjamin Mou and Dawn Owen and Park, {Sean S} and Katy Nelson and Christopher Hallemeier and Terence Sio and Garces, {Yolanda Isabel} and Olivier, {Kenneth R.} and Merrell, {Kenneth W.}",
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AU - Arnett, Andrea L.H.

AU - Mou, Benjamin

AU - Owen, Dawn

AU - Park, Sean S

AU - Nelson, Katy

AU - Hallemeier, Christopher

AU - Sio, Terence

AU - Garces, Yolanda Isabel

AU - Olivier, Kenneth R.

AU - Merrell, Kenneth W.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Previous studies suggest that stereotactic body radiation therapy (SBRT) is associated with higher toxicity rates for central lung tumors relative to peripheral tumors when using 3 fraction SBRT. The initial results from Radiation Therapy Oncology Group study 0813 suggest a safe toxicity profile of SBRT administered in 5 fractions for central non-small cell lung cancer (NSCLC). We reviewed our institutional data to evaluate the safety and efficacy of SBRT for central NSCLC. Methods and materials: We reviewed our prospectively collected SBRT database for patients with central NSCLC who received SBRT between 2008 and 2014. The most frequent dose and fractionations were 50 Gy in 5 fractions (59%) and 48 Gy in 4 fraction (30%). Local control (LC), regional control, metastasis-free survival, and overall survival were calculated using Kaplan-Meier estimates. The National Cancer Institute Common Terminal Criteria for Adverse Events were used for toxicity grading. Results: A total of 110 central lung tumors in 103 patients were included. The median age was 74 years (range, 40-95 years), and the median follow-up time of living patients was 50 months. The mean tumor size was 20 mm (range, 5-70 mm). The 5 year rate of LC, regional control, and distant control was 89%, 77%, and 82%, respectively. The median and 5-year overall survival were 3.5 years and 35%, respectively. No treatment variables were associated with tumor control or other clinical outcomes. A single patient experienced grade 3 radiation pneumonitis (0.97%). The rate of late toxicity grade ≥3 was 9.7% (grade 3, 7.7%; grade 4, 0.97%; grade 5, 0.97%) and included pneumonitis (3.9%), bronchial necrosis (2.9%), myocardial dysfunction (1.9%), and worsening heart failure (0.97%). Conclusions: SBRT for central NSCLC provides high rates of LC. Despite excellent LC, patients remain at risk for regional and distant failure. The rate of grade 3 pneumonitis was consistent with that of prior reports. We observed low rates of grade 4-5 toxicity potentially attributable to SBRT. Our results contribute to the growing body of data in support of the safety of SBRT for central NSCLC.

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