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• W2049064797 abstract "Four years into our lung stereotactic body radiotherapy (SBRT) experience, analysis suggested no differences in local failure (LF) by dose/fractionation schedule for patients with medically inoperable stage I non-small cell lung cancer (NSCLC). Now with 10 years of experience we seek to re-confirm this association. Using December 31, 2013, as the last follow-up date for this analysis we reviewed an IRB approved registry of patients treated with definitive intent lung SBRT for stage I NSCLC between October 2003 and December 2012. Patients were treated on a Novalis/BrainLAB system with motion controlled by abdominal compression or breath-hold and image guidance during delivery by Exactrac. Patient, tumor, and treatment factors were analyzed for correlation with LF using Cox proportional hazards. Six hundred patients were identified for analysis: Median age 74 (37-97 years), Charlson score 3 (0-12), pre-SBRT hemoglobin (HGB) 12.8 (8.2-17.8), FEV1 1.34L, and DLCO 53%. Fifty-three percent were men, 21% active smokers, and 94% medically inoperable (61% pulmonary, 20% cardio-vascular, 6% refused, 4% age/KPS, 10% other). Median tumor size was 2.2 cm (mean 2.6, range 0.7-10 cm), PET SUV 7.49 (1-59), 75% were peripheral per RTOG 0236 definition, and 78% had biopsy proven disease (22% radiographic). SBRT dose was at physician discretion using a risk adapted and trial based approach: 351 patients (59%) received 48-50 Gy in 4-5 fx, 131 (22%) 60 Gy/3 fx, 88 (15%) 30-34 Gy/1 fx, and 30 (5%) 60 Gy/8 fx or 50 Gy/10 fx. At last follow-up 53% of patients had died, and median overall survival was 31.9 months. Crude rates of local, lobar, regional, distant and any failure were 9, 4, 12, 25, and 34%, respectively. Univariate correlates with LF were pre-SBRT HGB (p = 0.045, HR = 0.84), PET SUV (p = 0.027, HR = 1.04) and SBRT schedule (p = 0.037) with 60 Gy/3 fx associated with the lowest LF. Compared to 3 fx, HR for LF for 4-5 fx 3.15 (p = 0.011), 1 fx was 4.35 (p = 0.006), and 8-10 fx 3.85 (p = 0.038). While 1 year local control was 95-99% for all groups, 3 year actuarial local control was 96.5 v 81.2 v 79% for 3, 4-5, and 1 fraction regimens, respectively. On multivariate analysis pre-SBRT HGB (p = 0.044), PET SUV (p = 0.046), and choice of either 4-5 (p = 0.031) or 1 (p = 0.019) versus 3 fraction regimens remained significant. While it was correlated with local control, SBRT fractionation was not statistically significantly associated with overall survival (p = 0.22). (1) Given the association of 60 Gy in 3 fractions with reduced LF we recommend further study of the ideal dose/fractionation regimen in stage I NSCLC, preferably in a randomized trial. (2) Maximum PET SUV (non-modifiable) and pre-SBRT HGB (modifiable) were also correlated with LF." @default.
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• W2049064797 date "2014-09-01" @default.
• W2049064797 modified "2023-10-06" @default.
• W2049064797 title "Time Will Tell: Is 60 Gy in 3 Fractions the Optimal SBRT Schedule for Stage I Non-Small Cell Lung Cancer?" @default.
• W2049064797 doi "https://doi.org/10.1016/j.ijrobp.2014.05.130" @default.
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