title: Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries.
abstract: We reviewed results of SBRT treatment of 138 patients with medically inoperable stage I NSCLC treated during 1996-2003 at five different centres in Sweden and Denmark. Mean age was 74 years (range 56-90) with 69 men and 72 women. SBRT was delivered using a 3D conformal multifield technique and a stereotactic body frame. Doses delivered were 30-48 Gy (65% isodose at the periphery of planning target volume, PTV) in 2-4 fractions. Equivalent dose in 2 Gy fractions (EQD2) was in the range of 50-100 Gy. Mean gross tumour volume (GTV) was 39 cm3 (2-436), and planning target volume was 101 cm3 (11-719). Overall response rate (CR, PR) was 61% (84/138). SD was noted in 36% (50/138). During a median follow-up period of 33 months (1-107), 16 (12%) local failures occurred, ten of which also included distant metastases. Local failure was associated with tumour size, target definition and central or pleura proximity. Distant metastases occurred in 25% (35/138) of the patients. Ninety-one (65%) patients died during follow-up of which 55 patients (60%) died of other causes than lung cancer. Three- and 5-year overall survival was 52 and 26% respectively. Lung cancer specific 3- and 5-year overall survival was 66 and 40% respectively. Fifty nine percent (83/138) of the patients had no side effects. Fourteen patients experienced grade 3-4 toxicity according to radiation therapy oncology group (RTOG). EQD2 (> v.s.<55.6 Gy) showed a statistically significant benefit survival for the higher doses. SBRT for stage I NSCLC results in favourable local control not inferior to fractionated RT and with acceptable toxicity.
authors.affiliation: Division of Oncology and Hospital Physics, Radiumhemmet Karolinska University Hospital, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Baumann
authors.forename: Jan
authors.initials: J
authors.lastname: Nyman
authors.forename: Ingmar
authors.initials: I
authors.lastname: Lax
authors.forename: Signe
authors.initials: S
authors.lastname: Friesland
authors.forename: Morten
authors.initials: M
authors.lastname: Hoyer
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rehn Ericsson
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.forename: Lars
authors.initials: L
authors.lastname: Ekberg
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Morhed
authors.forename: Merete
authors.initials: M
authors.lastname: Paludan
authors.forename: Lena
authors.initials: L
authors.lastname: Wittgren
authors.forename: Henrik
authors.initials: H
authors.lastname: Blomgren
authors.forename: Rolf
authors.initials: R
authors.lastname: Lewensohn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011336:Probability; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome