SESSION TYPE: End of Life Care Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Stereotactic body radiation therapy (SBRT) has been advocated for inoperable patients with stage I non-small cell lung cancer (NSCLC). However, limited SBRT outcomes data exists for inoperable patients with stage II NSCLC. We report toxicity, local control, and overall survival of CyberKnife delivered SBRT for inoperable stage II NSCLC.
METHODS: Inoperable stage II NSCLC (TNM classification, 7th Ed.) patients treated using the CyberKnife with Synchrony fiducial tracking were retrospectively reviewed. Gold fiducial markers were implanted by conventional bronchoscopy within or adjacent to tumors to serve as targeting references. A prescribed dose of 30 to 60 Gy was delivered to the gross tumor volume (GTV). Clinical examination and imaging were performed at 3 to 6-month follow-up intervals.
RESULTS: Twenty patients (median age 80 years) with a median ECOG performance status of 2 (range, 1-3) were treated over a 5-year period extending from March 2007 to March 2012. The median GTV was 143 cc (range, 28 - 432 cc). The majority of patients were clinical stage IIB (65%). A mean dose of 45 Gy was delivered to the prescription isodose line in 3 to 5 fractions (median 5 fractions). The median percentage of the total lung volume receiving at least 15 Gy was 14% (range, 7% - 25%). At a median 12 months follow-up, the 1-year Kaplan-Meier local control and overall survival rates were 77% and 75%, respectively. During the first year, transient mild to moderate chest wall discomfort, typically lasting several weeks, developed in patients with lesions within 5 mm of the pleura. Toxicities included one patient with severe COPD experiencing acute grade II radiation pneumonitis.
CONCLUSIONS: CyberKnife is a well tolerated treatment option for stage II NSCLC. Local control and survival were surprisingly good given the relatively low doses delivered and the large tumor volumes treated in this predominately elderly group of poor performance status patients ineligible for chemotherapy.
CLINICAL IMPLICATIONS: CyberKnife is a novel treatment option for inoperable patients with stage II NSCLC.
DISCLOSURE: Sean Collins: Consultant fee, speaker bureau, advisory committee, etc.: Paid lectures for Accuray
Brian Collins: Consultant fee, speaker bureau, advisory committee, etc.: paid lectures for Accuray
The following authors have nothing to disclose: Shaan Kataria, Raeva Malik, Eric Oermann, Saloomeh Vahdaat, Simeng Suy, Xia Yu, Lloyd Campbell, Dina KiaNoury, Eric Anderson
No Product/Research Disclosure InformationGeorgetown University Hospital, Department of Radiation Medicine, Washington, DC