title: Locoregional and distant failure following image-guided stereotactic body radiation for early-stage primary lung cancer.
abstract: OBJECTIVE
  To report our institutional experience using image-guided stereotactic body radiation therapy (SBRT) for early stage lung cancer, including an analysis into factors associated with nodal and distant failures (NF, DF).
  
  
  METHODS
  Forty-eight patients with early-stage primary lung cancer were treated with image-guided SBRT between 2007 and 2009. Median prescription dose was 48 Gy in 4 fractions. Toxicity was graded according to the NCI CTCAE v3.0 scale.
  
  
  RESULTS
  Local failure was detected in two lesions and actuarial 24-month local control was 95%. At 24 months, the cumulative incidence of NF was 6%, and DF was 29%. Larger lesions (>3 cm) and younger age (<70 years) were the only factors found to be significantly correlated with increased DF (p=0.005 and p=0.015, respectively). A single grade ≥ 3 toxicity was observed. After adjusting for age and lesion size, distant failure was significantly associated with a poorer OS (Cox regression, p=0.0059).
  
  
  CONCLUSIONS
  Image-guided SBRT can produce excellent LC rates with minimal toxicity. Distant failure was a major determinant of OS and the most common pattern of failure, indicating a potential role for systemic therapy in younger patients with large lesions.
authors.affiliation: Department of Radiation Oncology, UCSD Moores Cancer Center, La Jolla, CA 92093-0843, USA.
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Nath
authors.forename: Ajay P
authors.initials: AP
authors.lastname: Sandhu
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.forename: Anjali
authors.initials: A
authors.lastname: Bharne
authors.forename: Polly D
authors.initials: PD
authors.lastname: Nobiensky
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lawson
authors.forename: Mark
authors.initials: M
authors.lastname: Fuster
authors.forename: Lyudmila
authors.initials: L
authors.lastname: Bazhenova
authors.forename: William Y
authors.initials: WY
authors.lastname: Song
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Mundt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure