title: Stereotactic radiosurgery for the treatment of lung neoplasm: initial experience.
abstract: BACKGROUND
  Surgical resection is the standard of care for patients with resectable non-small cell lung carcinoma (NSCLC) or limited pulmonary metastases. Stereotactic radiosurgery (SRS) may offer an alternative option for high-risk patients who are not surgical candidates. We report our initial experience with SRS in the treatment of lung neoplasm.
  
  
  METHODS
  Patients who were medically inoperable were offered SRS. Thoracic surgeons evaluated all patients, placed fiducials, and planned treatment in collaboration with radiation oncologists. A median dose of 20 Gy prescribed to the 80% isodose line was administered in a single fraction. The initial response rate, time to progression, and overall survival were evaluated.
  
  
  RESULTS
  During a 2-year period, 32 patients, 27 with NSCLC and 5 with pulmonary metastases, underwent SRS. Fiducial placement resulted in a pneumothorax requiring a pigtail catheter in 9 patients (28%). An initial complete response was observed in 7 patients (22%) and partial response in 10 (31%). Disease was stable in 9 (28%) and progression occurred in 5 patients (16%), with a median time to local progression of 11 months. The median overall survival was 26 months. The probability of 1-year overall survival was 78% (95% confidence interval [CI], 65% to 94%) for the entire group and 91% (95% CI, 75% to 100%) for stage I patients.
  
  
  CONCLUSIONS
  Our preliminary experience indicates that SRS has reasonable results in this high-risk group of patients, with pneumothorax being a significant morbidity. Surgery continues to offer the best chance of cure for resectable patients; however, SRS offers an alternative to high-risk patients.
authors.affiliation: Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Steven
authors.initials: S
authors.lastname: Burton
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
authors.forename: William E
authors.initials: WE
authors.lastname: Gooding
authors.forename: Cihat
authors.initials: C
authors.lastname: Ozhasoglu
authors.forename: Jill
authors.initials: J
authors.lastname: Ireland
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome