title: Definitive Treatment of Early-Stage Non-Small Cell Lung Cancer with Stereotactic Ablative Body Radiotherapy in a Community Cancer Center Setting.
abstract: BACKGROUND
  Stereotactic ablative body radiotherapy (SABR) provides a superior non-small cell lung cancer (NSCLC) treatment option when compared to conventional radiotherapy for patients deemed inoperable or refusing surgery. This study retrospectively analyzed the rates of tumor control and toxicity following SABR treatment (Cyberknife system) of primary early-stage NSCLC in a community setting.
  
  
  METHODS
  One hundred patients were treated between 2007 and 2011. Patients with T3-4 or N1-3 disease, metastasis, recurrent local disease, or a non-lung primary were excluded from analysis. All patients had biopsy proven disease. Staging included CT or fluorodeoxyglucose-positron emission tomography scan. Median dose was 54 Gy (45-60); 18 Gy (10-20) per fraction. Median planned target volume expansion was 8 mm (2-10). Median BED was 151.2. Tumors were tracked via Synchrony, X-Sight Lung, or X-Sight Spine. Patients were evaluated for local control, overall survival (OS), and toxicity. All local failures were determined by evaluating post treatment PET/CT.
  
  
  RESULTS
  With a median follow up of 27.5 months, the 1-, 2-, and 3-year local control rates were 100, 93.55, and 84.33%, respectively. Median survival was 2.29 years; actuarial 3-year survival was 37.20%. Grade-3 toxicity was observed in 2% of patients (pneumonia within 2 months of treatment, n = 1; chronic pneumonitis requiring hospital admission, n = 1). No patients demonstrated toxicity above Grade-3. Multivariate analysis did not show T-stage as an independent predictor of OS, though it did trend toward significance.
  
  
  CONCLUSIONS
  In a community-center setting, definitive treatment of NSCLC with SABR for non-surgical candidates and those who choose to forego surgery result in excellent and comparable rates of local control and toxicity compared to published series from large academic centers.
authors.affiliation: Drexel University College of Medicine , Philadelphia, PA , USA.
authors.forename: Cory
authors.initials: C
authors.lastname: Heal
authors.affiliation: Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife , Philadelphia, PA , USA ; Crozer Keystone Healthcare System , Philadelphia, PA , USA.
authors.forename: William
authors.initials: W
authors.lastname: Ding
authors.affiliation: Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife , Philadelphia, PA , USA ; Crozer Keystone Healthcare System , Philadelphia, PA , USA.
authors.forename: John
authors.initials: J
authors.lastname: Lamond
authors.affiliation: David Geffen School of Medicine at UCLA , Los Angeles, CA , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wong
authors.affiliation: Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife , Philadelphia, PA , USA ; Crozer Keystone Healthcare System , Philadelphia, PA , USA.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Lanciano
authors.affiliation: Fox Chase Cancer Center , Philadelphia, PA , USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Su
authors.affiliation: Philadelphia CyberKnife , Philadelphia, PA , USA ; Crozer Keystone Healthcare System , Philadelphia, PA , USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: Philadelphia CyberKnife , Philadelphia, PA , USA ; Crozer Keystone Healthcare System , Philadelphia, PA , USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Feng
authors.affiliation: Philadelphia CyberKnife , Philadelphia, PA , USA ; Crozer Keystone Healthcare System , Philadelphia, PA , USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Arrigo
authors.affiliation: Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife , Philadelphia, PA , USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Markiewicz
authors.affiliation: University of Pennsylvania , Philadelphia, PA , USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.affiliation: Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife , Philadelphia, PA , USA.
authors.forename: Luther
authors.initials: L
authors.lastname: Brady
keywords: XSight; cyberknife; early-stage lung cancer; non-small cell lung cancer; radiation oncology; radiation toxicity; stereotactic ablative radiotherapy; stereotactic body radiotherapy