title: Stereotactic body radiotherapy using a radiobiology-based regimen for stage I non-small-cell lung cancer: five-year mature results.
abstract: BACKGROUND
  Although the protocol of 48 Gy in four fractions over 4 days has been most often employed in stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer in Japan, higher doses are necessary to control larger tumors, and interfraction intervals should be longer than 24 hours to take advantage of reoxygenation. We report the final results of our study testing the following regimen: for tumors less than 1.5, 1.5-3, and greater than 3 cm in diameter, 44, 48, and 52 Gy, respectively, were given in four fractions with interfraction intervals of greater than or equal to 3 days.
  
  
  METHODS
  Among 180 histologically proven patients entered, 120 were medically inoperable and 60 were operable. The median patient age was 77 years (range, 29-89). SBRT was performed with 6-MV photons using four noncoplanar and three coplanar beams. Isocenter doses of 44, 48, and 52 Gy were given to four, 124, and 52 patients, respectively.
  
  
  RESULTS
  The 5-year overall survival rate was 52.2% for all 180 patients and 66% for 60 operable patients. The 5-year local control rate was 86% for tumors less than or equal to 3 cm (44/48 Gy) and 73% for tumors greater than 3 cm (52 Gy; p = 0.076). Grade greater than or equal to 2 radiation pneumonitis developed in 13% (10% for the 44/48-Gy group and 21% for the 52-Gy group; p = 0.056). Other grade 2 toxicities were all less than 4%.
  
  
  CONCLUSIONS
  Our first prospective SBRT study yielded reasonable local control and overall survival rates and acceptable toxicity. Refinement of the protocol including dose escalation may lead to better outcome.
authors.affiliation: *Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; †Radiosurgery Center, Nagoya Kyoritu Hospital, Nagoya, Japan; ‡Department of Radiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan; and §Department of Radiology, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
authors.forename: Chisa
authors.initials: C
authors.lastname: Hashizume
authors.forename: Fumiya
authors.initials: F
authors.lastname: Baba
authors.forename: Shiho
authors.initials: S
authors.lastname: Ayakawa
authors.forename: Akifumi
authors.initials: A
authors.lastname: Miyakawa
authors.forename: Taro
authors.initials: T
authors.lastname: Murai
authors.forename: Taiki
authors.initials: T
authors.lastname: Takaoka
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Hattori
authors.forename: Ryuji
authors.initials: R
authors.lastname: Asai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods*; D016019:Survival Analysis