title: Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer.
abstract: For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population.
  
  
  
  The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes.
  
  
  
  From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and "elsewhere lung" (20.8%). The median time to each was 5 to 7 months.
  
  
  
  From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Simone
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Gajjar
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Weining
authors.initials: W
authors.lastname: Zhen
authors.affiliation: Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Harkenrider
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hallemeier
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
authors.affiliation: Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma.
authors.forename: Chance L
authors.initials: CL
authors.lastname: Matthiesen
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Steve E
authors.initials: SE
authors.lastname: Braunstein
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Percy
authors.initials: P
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Dilling
authors.affiliation: Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Allen
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Nichols
authors.affiliation: Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Albert
authors.initials: A
authors.lastname: Attia
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Jing
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Department of Radiation Oncology, University Hospitals Siedman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Tithi
authors.initials: T
authors.lastname: Biswas
authors.affiliation: Division of Radiation Oncology, Department of Oncology, Barbara Ann Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Peter
authors.initials: P
authors.lastname: Paximadis
authors.affiliation: Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Fen
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Walker
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: John M
authors.initials: JM
authors.lastname: Stahl
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Daly
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Decker
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Russell K
authors.initials: RK
authors.lastname: Hales
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Henning
authors.initials: H
authors.lastname: Willers
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Gregory M M
authors.initials: GM
authors.lastname: Videtic
authors.affiliation: Miami Cancer Institute, Baptist Health South Florida, Coral Gables, Florida.
authors.forename: Minesh P
authors.initials: MP
authors.lastname: Mehta
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: shlin@mdanderson.org.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D016371:Cranial Irradiation / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017564:Radiation Pneumonitis / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents