Stereotactic body radiotherapy in primary lung disease: Experience of a portuguese center
DOI:
https://doi.org/10.32932/gecp.2021.07.012Keywords:
NSCLC, Stereotactic Radiotherapy, SBRT, lung cancer, early stageAbstract
Background: Stereotactic body radiation therapy (SBRT) is the primary alternative to surgery for patients with clinical stage I or II non -small cell lung cancer (NSCLC) who have significant comorbidity that precludes safe resection and for those who refuse surgery.Methods: Patients with clinical stage I or II NSCLC treated with SBRT in our institution between January 2015 and December 2019 were retrospectively analyzed. Patient characteristics, treatment -related outcomes and toxicities were analyzed. Control and survival rates were calculated using the Kaplan -Meier method. Acute and late toxicities were graded according to the CTCAE v4.0.
Results: 110 patients were identified, 78 men and 32 women, with a median age of 75,5 years (50 -90 years), and a ECOG performance status of 0 or 1 in 73% of these patients. Of the biopsy proven cases (65%), 36% were adenocarcinomas and 21% were squamous cell carcinomas. 65% patients were staged as IA (T1N0), 33% as IB (T2aN0) and 2% as IIB (T3N0), all of which were clinically staged with PET -CT. The majority of the tumors (70%) were peripherally located, with a median size of 24.3mm. 48Gy in 4 fractions was the most prescribed scheme (70%), followed by 50Gy in 5 fractions (17.3%). 110 patients were eligible for assessment of recurrence. With a median follow -up of 53 months (IC95% 42 to 57 months), 32 patients (29.1%) had disease recurrence, of which 10% failed locally, 7.3% had regional failure and 22.7% distant failure. The 2 - and 5 -year local control was 91% and 85%, respectively. The 2 - and 5 -year regional control were both 92%, and the distant metastasis free survival and overall survival (OS) were 80% and 67%; 75% and 45%, respectively. Median OS was 51,3 months. No grade 3 toxicity was reported. Late grade 2 toxicity occurred in 26% of patients (11% pneumonitis, 7% fatigue, 2% rib fracture, 4% chest wall pain, and 2% esophagitis). Prognostic factors correlated with better OS were: age <70 years (p = 0.03), female gender (p = 0.005), absence of cardiac and/or pulmonary comorbidities (p = 0.03) and good performance status 0 -1 (p = 0.001).
Conclusion: High rates of local control were achieved in our population of early stage NSCLC patients treated with SBRT, with good survival outcomes and toxicity profile, comparable to other published data. SBRT is safe and efficacious in the definitive treatment of patients with early stage NSCLC (I/II).
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