title: Treatment of multiple primary lung cancers using stereotactic radiotherapy, either with or without surgery.
abstract: OBJECTIVE
  Multiple primary lung cancers (MPLC) are not an uncommon presentation. Current guidelines recommend a curative approach when early-stage MPLC is diagnosed as favorable outcomes have been reported after surgery. We studied outcomes following stereotactic ablative radiotherapy (SABR).
  
  
  METHODS
  Following review of imaging and pathology at a multi-disciplinary tumor board, a total of 62 patients were referred for SABR with a diagnosis of synchronous MPLC. SABR was performed for both lesions in 56 patients, while another 6 underwent SABR for only one lesion and surgery for the other lesion. A total dose of 54-60 Gy was delivered in 3-8 fractions.
  
  
  RESULTS
  Median follow-up was 44 months (95% CI: 29-59). Overall survival of all patients was 31 months (95% CI: 17-44), with an actuarial 2-year survival of 56%. No grade 4 or 5 post-SABR toxicity was observed. Local control rates calculated per lesion, were 84% at 2 years, and 78% at 3 years. The two-year actuarial regional control rate was 87%.
  
  
  CONCLUSIONS
  SABR for synchronous MPLC achieves a lesion control rate of 84% after 2 years, with limited toxicity. SABR should be considered when patients with lung cancer present with a synchronous second lesion and no nodal involvement.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Gwendolyn H M J
authors.initials: GH
authors.lastname: Griffioen
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.forename: Cornelis J A
authors.initials: CJ
authors.lastname: Haasbeek
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed
keywords: Lung cancer; Multiple primary lung cancers; Stereotactic ablative radiotherapy; Survival