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• W2162548897 abstract "To compare two SBRT fractionation schemes in medically inoperable early-stage NSCLC for tumor control, pulmonary function and treatment toxicity. We reviewed 94 SBRT treatments in 86 patients with stage I NSCLC receiving either 50 Gy in 5 fractions (n = 56) or 60 Gy in 3 fractions (n = 38) from 10/2003 to 8/2007. Institutional practice was 50 Gy prior to 6/1/2006 when 60 Gy became predominant after RTOG accreditation. Patient characteristics (age, gender, KPS, pack-years smoking, smoking status, tumor size, stage, PET SUV, pre-treatment hemoglobin, pre-treatment FEV1 and DLCO) were balanced between the groups when compared by lesions treated. Median age was 73 years and median KPS 80. 69 lesions were T1, 24 were T2. Median tumor size was 2.2 cm in the 50 Gy group and 2.35 cm in the 60 Gy group (p = 0.43). Median follow-up was 15.3 months and was significantly longer for the 50 Gy group (19.8 vs. 9.8 months, p < 0.0001). Actuarial rates of overall survival as well as local, nodal, and distant control were unaffected by fractionation group. For the 50 Gy and 60 Gy cohorts; at one year, local control was 97.3% vs. 100%, nodal failure 7.3% vs. 3.4%, distant metastasis rate 21.8% vs. 29.5%, and overall survival 83.1 vs. 76.9%, no differences were significant (p = 0.68, p = 0.54, p = 0.56, and p = 0.54 respectively). Higher KPS was associated with more nodal and distant metastasis (p = 0.04, p = 0.005) but not with survival (p = 0.9116). No other patient, tumor, or treatment factor was associated with nodal or distant metastasis. Greater smoking history and larger tumor size were multivariate predictors of lower overall survival (p = 0.022, p = 0.009). There was one case (1.2%) of clinical grade 3 pneumonitis. There was no decline in FEV1 at 6 months overall or by fractionation. Six month DLCO declined overall (median pre-SBRT 56%, median decline 7%, p = 0.024), but there was no difference between SBRT schedules (p = 0.31). Late chest wall toxicity was seen in 9 patients (10%), and was more common in the 60 Gy group (7 of 38 [2 grade I, 5 grade II] vs. 2 of 56, p = 0.028). Median time to chest wall toxicity was 8.4 months in the 60 Gy group. There was a trend for chest wall toxicity with greater tumor dimension (2.8 cm in those with toxicity vs. 2.2 cm in those without, p = 0.054). 1) Local control is excellent in all patients and appears independent of fractionation. 2) Overall survival, nodal failure and distant failure are not associated with either fractionation. 3) Smoking history and tumor size were associated with worse survival. 4) Chest wall toxicity was more common with 60 Gy and may be associated with tumor size. Longer follow-up is needed to better assess this late effect." @default.
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• W2162548897 date "2008-09-01" @default.
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• W2162548897 title "A Comparison of Stereotactic Body Radiation (SBRT) Fractionation Schedules for Stage I Non-small Cell Lung Cancer (NSCLC): The Cleveland Clinic Experience" @default.
• W2162548897 doi "https://doi.org/10.1016/j.ijrobp.2008.06.852" @default.
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