title: Stereotactic ablative radiotherapy (SABR) using 70 Gy in 10 fractions for non-small cell lung cancer: exploration of clinical indications.
abstract: OBJECTIVE
  We report our outcomes for patients with NSCLC treated with SABR to 70 Gy in 10 fractions and propose indications for this regimen as well as new dose-volume constraints.
  
  
  METHODS
  Volumetric image-guided SABR was used to treat 82 patients with clinical challenging NSCLC, not suitable for 50 Gy in 4 fractions, to a final dose of 70 Gy in 10 fractions. Endpoints included overall survival (OS), toxicity, and disease control.
  
  
  RESULTS
  At a median follow-up time of 21.1 months, 2-year OS and local control rates were 66.9% and 96.2%, respectively. The most common side effects were radiation pneumonitis (14.6% grade 2, 2.4% grade 3), followed by chest wall pain (4.9% grade 2, 1.2% grade 3). Multivariate analysis revealed chest wall V50>60 cm(3) to be associated with chest wall pain. No patient developed brachial plexopathy. One patient with bronchial tree tumor invasion died of hemoptysis.
  
  
  CONCLUSIONS
  SABR with 70 Gy in 10 fractions appears to achieve excellent local control and acceptable toxicity for clinically challenging cases with improved tolerance of the chest wall and brachial plexus as compared with 50 Gy in 4 fractions. This regimen may not be suitable in patients with tumor invading critical central structures. More studies are needed to validate our conclusions.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Qiaoqiao
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Cameron W
authors.initials: CW
authors.lastname: Swanick
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: James W
authors.initials: JW
authors.lastname: Welsh
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Balter
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. Electronic address: jychang@mdanderson.org.
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017564:Radiation Pneumonitis / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D025321:Surgery, Computer-Assisted; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Central lesion; Hypofractionation; NSCLC; SABR; SBRT