Elsevier

Radiotherapy and Oncology

Volume 85, Issue 3, December 2007, Pages 429-434
Radiotherapy and Oncology

Lung cancer SBRT
A phase II study on stereotactic body radiotherapy for stage I non-small cell lung cancer

https://doi.org/10.1016/j.radonc.2007.10.017Get rights and content

Abstract

Background and purpose

The outcome of stage I non-small cell lung cancer (NSCLC) patients treated with conventional radiotherapy is inferior to that of patients treated surgically. We aimed to evaluate the clinical outcome of stereotactic body radiotherapy (SBRT) in the treatment of stage I NSCLC.

Materials and methods

We performed SBRT for 31 stage I NSCLC patients. Of these, 20 were medically inoperable, and 11 refused surgery. Nineteen tumours were T1-stage masses, and 12 tumours were T2. Median tumour size was 25 mm. SBRT was administered as 45 Gy/3 fractions; however, when the tumour was close to an organ at risk, 60 Gy/8 fractions were used. These doses were prescribed at the centre of the tumours.

Results

The median duration of observation for all patients was 32 months (range, 4–87 months). In 9 of the 31 cases, local recurrence was observed. The 3-year local control rates of T1 and T2 tumours were 77.9% and 40.0%, respectively. The 3-year overall and cause-specific survival rates were 71.7% and 83.5%, respectively. Although the symptoms improved with medical treatment, 5 patients developed acute pulmonary toxicity ⩾grade 2.

Conclusions

SBRT is safe and effective for stage I NSCLC patients. However, a more intensive treatment regimen should be considered for T2 tumours.

Section snippets

Patient eligibility

All patients included in this study had histological or cytological diagnoses of NSCLC and were staged as Union International Contre le Cancer (UICC) stage IA or IB (up to 5 cm) after appropriate staging studies. All the patients had either a medical contraindication to surgery or refused surgery. Further, all had a performance status of ⩽2 according to the World Health Organization guidelines. Patient eligibility was not restricted on the basis of tumour location, unless a part of the

Patients

Between March 1998 and December 2004, 34 patients with stage I NSCLS were registered with this study. However, 3 patients were excluded due to dose constraints related to the heart, hilus, and oesophagus, respectively. We treated 31 patients with stage I NSCLC with hypofractionated high-dose SBRT at Tohoku University Hospital (Table 1). Of the 31 patients, 20 were medically inoperable and 11 refused surgery. Further, 25 patients were men and 6 were women. Their median age was 77 years (range,

Discussion

The optimum protocol of SBRT for NSCLC has not been established, although several protocols and clinical results have been previously reported [16], [19], [32]. When we designed this protocol, 2 clinical results of SBRT had been reported for stage I NSCLC [1], [31]. Both reported excellent local control rates of >90% using 50 Gy/5 fractions [31] and 60 Gy/8 fractions [1]. We calculated biologic effective dose (BED) as nd [(1 + d/α/β), where n is the number of fractions, d is the fraction size, and α

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