Definitive Upfront Stereotactic Ablative Radiotherapy Combined with Image-Guided, Intensity Modulated Radiotherapy (IG-IMRT) or IG-IMRT Alone for Locally Advanced Non-Small Cell Lung Cancer.
BACKGROUND
Image-guided (IG) intensity-modulated radiotherapy (IMRT) enables maximal tumor margin reduction for the sparing of organs at risk (OARs) when used to treat locally advanced non-small cell lung cancer (NSCLC) with definitive chemo-radiation. It also allows for the incorporation of stereotactic ablative radiotherapy (SABR) into the treatment regimen. Here, we describe our initial experience in combining definitive upfront SABR to the primary lesion with chemo-radiation delivered with conventionally fractionated IG-IMRT to the remaining regional disease; along with clinical outcome following chemo-radiation with conventionally fractionated IG-IMRT alone in the treatment of locally advanced NSCLC.


METHODS
The clinical outcome of 29 patients with locally advanced NSCLC who underwent conventionally fractionated IG-IMRT, or definitive upfront SABR followed by IG-IMRT combined with chemotherapy (induction, concurrent, or both) was retrospectively reviewed.


RESULTS
After a median follow up of 23.7 months, the median overall survival (OS) and progression-free survival (PFS) were 19.8 and 11.3 months, respectively. The 2 year local, regional, and distant control was 60%, 62%, and 38%, respectively. No local failure was observed in 3 patients following SABR + IG-IMRT while 6/26 patients failed locally following IG-IMRT alone. SABR + IG-IMRT was well tolerated. No ≥ grade 3 radiation-related toxicity was observed.


CONCLUSIONS
Definitive upfront SABR followed by IG-IMRT in selected patients with locally advanced NSCLC warrants further investigation in future clinical trials, while chemo-radiation with IG-IMRT alone was well tolerated.
Mary Babb Randolph Cancer Center of West Virginia University, Morgantown, WV, United States of America.
Alexander
A
Chi
Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States of America.
Sijin
S
Wen
Oncology, Bristol Meyers Squibb, Princeton, NJ, United States of America.
Manish
M
Monga
Division of Hematology & Oncology, Mary Babb Randolph Cancer Center of West Virginia University, Morgantown, WV, United States of America.
Mohammed
M
Almubarak
Department of Pharmaceutical Sciences, West Virginia University, Morgantown, WV, United States of America.
Xiaoqing
X
He
Department of Pharmaceutical Sciences, West Virginia University, Morgantown, WV, United States of America.
Yon
Y
Rojanasakul
Department of Hematology, James Graham Brown Cancer Center of the University of Louisville, KY, United States of America.
William
W
Tse
Division of Hematology & Oncology, Mary Babb Randolph Cancer Center of West Virginia University, Morgantown, WV, United States of America.
Scot C
SC
Remick
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies