title: Long-term clinical experience of high-dose ablative lung radiotherapy: high pre-treatment [18F]fluorodeoxyglucose-positron emission tomography maximal standardized uptake value of the primary tumor adversely affects treatment outcome.
abstract: OBJECTIVE
  The aim of this study was to report the long-term clinical experience with lung stereotactic ablative radiotherapy (SABR).
  
  
  METHODS
  Between April 2004 and December 2011, 58 of 92 consecutive lung SABR cases were treated with a curative purpose and were eligible for inclusion. Forty patients were treated for primary lung cancer, and eighteen were treated for locally confined recurrent tumors. The majority of the cases were medically inoperable (65.5%). A median five fractions with a total dose of 30-60Gy were prescribed to the planned target volume. We routinely performed an image-guided respiratory gating technique or four-dimensional computed tomography to minimize set-up errors and accurately determine target volumes.
  
  
  RESULTS
  The median follow-up was 23.8 (range, 1.5-77.2) months. The median age of the entire cohort was 73 (range, 48-90) years. The median gross tumor volume and maximal tumor diameter were 20 (range, 0.5-189.7) ml and 2.2 (range, 0.7-5.9) cm, respectively. The two-year local control (LC) rate was 92.1%, and the major pattern of failure was distant metastasis (25.9%). A high pre-treatment maximal standardized uptake value (mSUV) of the primary tumor significantly and adversely affected LC, local relapse-free survival, distant metastasis-free survival, cause-specific survival and overall survival. The toxicity rates (≥grade 2) were 34.5% and 35% for the central and peripheral tumors, respectively, and one grade 5 toxic event (death due to massive hemoptysis) occurred in a centrally located tumor at 16.7 months post-SABR.
  
  
  CONCLUSIONS
  Lung SABR remains an effective and safe local treatment modality. Pre-treatment mSUV may be a helpful parameter to select patients requiring higher radiation doses and adjuvant systemic therapy for lung SABR.
authors.affiliation: Multidisciplinary Team of Lung Cancer in Seoul St. Mary's Hospital, Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
authors.forename: Yeon Sil
authors.initials: YS
authors.lastname: Kim
authors.forename: Ie Ryung
authors.initials: IeR
authors.lastname: Yoo
authors.forename: Young Nam
authors.initials: YN
authors.lastname: Kang
authors.forename: Seoung Jun
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Oh
authors.forename: Young Kyoon
authors.initials: YK
authors.lastname: Kim
authors.forename: Young Pil
authors.initials: YP
authors.lastname: Wang
authors.forename: Jae Gil
authors.initials: JG
authors.lastname: Park
authors.forename: Jin-Hyoung
authors.initials: JH
authors.lastname: Kang
authors.forename: Dae Hee
authors.initials: DH
authors.lastname: Han
authors.forename: Myung Im
authors.initials: MI
authors.lastname: Ahn
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D049268:Positron-Emission Tomography; D016634:Radiosurgery; D015996:Survival Rate; D016896:Treatment Outcome