title: Comparison of accelerated hypofractionation and stereotactic body radiotherapy for Stage 1 and node negative Stage 2 non-small cell lung cancer (NSCLC).
abstract: OBJECTIVE
  Stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) have favorable local control (LC) relative to conventional fractionation in the treatment of stage I non-small cell lung cancer (NSCLC). We report the results of our single institution experience with the treatment of early stage NSCLC with SBRT or AHRT in cases where SBRT was felt to be suboptimal.
  
  
  METHODS
  One hundred and sixty patients with Stage 1 and node negative Stage 2 NSCLC were treated with SBRT or AHRT from 2003 to 2011. Median follow-up was 29.4 and 19 months (mo), respectively. The median dose was 54Gy in 3 fractions (fx) (SBRT) and 70.2Gy in 26 fx (AHRT). Acute and late toxicities (tox) were graded (G) per CTCAE v4. Time to local (LF), regional (RF) and distant (DF) failure were estimated using the Kaplan-Meier method. The impact of patient and tumor related factors on LF were estimated by multivariate Cox proportional hazard model.
  
  
  RESULTS
  Three-year LC rates were 87.7% (SBRT) and 71.7% (AHRT). The 3-year freedom from DF was 73.3% and 68.1%. Median OS was 38.4 (95% CI 29.7-51.6) and 35 (95% CI 22-48.3) mo. No G3 or 4 tox were observed. At 1 year, 30% and 50% of complications resolved, while (5-6%) had persistent chest wall pain. Multivariate analysis demonstrated that increasing dose per fraction and tumor size (>5.5 vs. 4cm) in the AHRT and SBRT group were found to be associated with a reduced (HR 0.33 95% CI 0.13-0.84, p=0.021) and increased (HR: 6.372 95% CI 1.23-32.92, p=0.027) hazard for local failure respectively.
  
  
  CONCLUSIONS
  Our results compare favorably with other reports of treatment for early stage NSCLC. AHRT patients had comparable LC despite increased size and central disease. Toxicity was limited and overall survival, regional and distant recurrences were similar between groups.
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States. Electronic address: johnthomas75@gmail.com.
authors.forename: John T
authors.initials: JT
authors.lastname: Lucas
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Kuremsky
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: Mike
authors.initials: M
authors.lastname: Soike
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: William W
authors.initials: WW
authors.lastname: Hinson
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: William T
authors.initials: WT
authors.lastname: Kearns
authors.affiliation: Southeastern Radiation Oncology Physics Group, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: Carnell J
authors.initials: CJ
authors.lastname: Hampton
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: A William
authors.initials: AW
authors.lastname: Blackstock
authors.affiliation: Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States.
authors.forename: James
authors.initials: J
authors.lastname: Urbanic
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Accelerated hypofractionated radiotherapy; Involved-field radiotherapy; Lung cancer; Non-small cell lung cancer; Radiation; Stereotactic body radiation therapy