title: Stereotactic radiosurgery for the treatment of stage I non-small cell lung cancer in high-risk patients.
abstract: OBJECTIVE
  Surgical resection is the standard of care for patients with stage I non-small cell lung cancer. For high-risk patients, however, stereotactic radiosurgery may offer an alternative. We report our initial experience with stereotactic radiosurgery for treatment of stage I non-small cell lung cancer by a team of thoracic surgeons and radiation oncologists.
  
  
  METHODS
  Patients medically ineligible for operation were offered stereotactic radiosurgery. Thoracic surgeons evaluated all patients, placed fiducials, and performed treatment planning in collaboration with radiation oncologists. Median dose of 20 Gy to 80% isodose line was administered as single fraction (range 20-60 Gy,1-3 fractions). Initial response rate, progression, and survival were monitored.
  
  
  RESULTS
  Twenty-one patients underwent stereotactic radiosurgery in 3 years. Fiducial placement resulted in pneumothorax requiring a pigtail catheter in 10 of 21 patients (47%). Disease showed initial response in 12 of 21 patients (57%), was stable in 5 (24%), progressed in 3 (14%), and was not evaluable in 1 (5%). Procedure-related mortality was zero. With mean 24-month follow-up, estimated 1-year survival probability was 81% (68% confidence interval 0.73-0.90). Median survival was 26.4 months (confidence interval 19.6 months-not reached). Local progression occurred in 9 patients (42%). Median time to local progression was 12.3 months (confidence interval 12 months-not reached).
  
  
  CONCLUSIONS
  Preliminary experience indicates that stereotactic radiosurgery (median dose 20 Gy) is safe in this high-risk group; however, it was associated with significant local progression. Further prospective studies with multiple fractions are needed to evaluate its efficacy in this population.
authors.affiliation: Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.forename: Steven
authors.initials: S
authors.lastname: Burton
authors.forename: Mang
authors.initials: M
authors.lastname: Chen
authors.forename: William E
authors.initials: WE
authors.lastname: Gooding
authors.forename: Cihat
authors.initials: C
authors.lastname: Ozhasoglu
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery; D012189:Retrospective Studies; D012307:Risk Factors