To evaluate the effect of baseline postbronchodilator percent predicted FEV1 on overall survival following radical stereotactic radiosurgery (RSR) for inoperable patients with peripheral Stage IA NSCLC.
Twenty-four medically inoperable patients with biopsy-proven peripheral clinical stage IA NSCLC were treated with RSR over a 4 year period and followed for a minimum of 6 months. Baseline patient characteristics, disease status, and survival data were collected. Actuarial survival was calculated using the Kaplan-Meier method. Univariate logistic regression analysis was performed to evaluate the correlation of baseline postbronchodilator % predicted FEV1 with overall survival.
The median age of the group was 76 years (range, 64 to 84) and the median baseline postbronchodilator % predicted FEV1 was 49% (range, 21–111). At a mean follow-up of 30 months, the 2-year Kaplan-Meier overall survival estimate for the group was 83%. However, for patients with a baseline postbronchodilator FEV1 < 40% predicted the 2 year Kaplan-Meier overall survival estimate was only 43%. There were no local failures or regional lymph node recurrences. Two patients are alive with distant lung metastases. Deaths were uniformly the result of progressive lung dysfunction in patients with severe emphysema (baseline post bronchodilator FEV1< 40% predicted) at 7, 8, 9, 18 and 25 months. Baseline postbronchodilator % predicted FEV1 correlated with overall survival (p= 0.045).
Radical sterotactic radiosurgery is a highly effective treatment for peripheral stage IA NSCLC. However, survival remains poor in patients with a baseline postbronchodilator FEV1 < 40% predicted.
Radical stereotactic radiosurgery is an effective nonsurgical treatment for inoperable patients with stage IA NSCLC. However, for patients with a baseline postbronchodilator FEV1 < 40% predicted, mortality remains high.
Eric Anderson, Grant monies (from sources other than industry) US Army (research grant); Consultant fee, speaker bureau, advisory committee, etc. Accuray (honoraria), Pentax (honoraria), Alveolus (honoraria), Calypso (consultant), SuperDimension (consultant); No Product/Research Disclosure Information