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01-02-2015 | Original article

Stereotactic body radiotherapy for centrally located stage I NSCLC

A multicenter analysis

Authors: Daniel H. Schanne, M.D., Ursula Nestle, M.D., Ph.D., Michael Allgäuer, M.D., Nicolaus Andratschke, M.D., Ph.D., Steffen Appold, M.D., Ute Dieckmann, M.D., Iris Ernst, M.D., Ute Ganswindt, M.D., Anca L. Grosu, M.D., Ph.D., Richard Holy, M.D., Michael Molls, M.D., Ph.D., Meinhard Nevinny-Stickel, M.D., Ph.D., Sabine Semrau, M.D., Florian Sterzing, M.D., Andrea Wittig, M.D., Ph.D., Matthias Guckenberger, M.D., Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 2/2015

Abstract

Purpose

The purpose of this work is to analyze patterns of care and outcome after stereotactic body radiotherapy (SBRT) for centrally located, early-stage, non-small cell lung cancer (NSCLC) and to address the question of potential risk for increased toxicity in this entity.

Methods and materials

A total of 90 patients with centrally located NSCLC were identified among 613 cases in a database of 13 German and Austrian academic radiotherapy centers. The outcome of centrally located NSCLC was compared to that of cases with peripheral tumor location from the same database.

Results

Patients with central tumors most commonly presented with UICC stage IB (50 %), while the majority of peripheral lesions were stage IA (56 %). Average tumor diameters were 3.3 cm (central) and 2.8 cm (peripheral). Staging PET/CT was available for 73 and 74 % of peripheral and central tumors, respectively. Biopsy was performed in 84 % (peripheral) and 88 % (central) of cases. Doses varied significantly between central and peripheral lesions with a median BED₁₀ of 72 Gy and 84 Gy, respectively (p < 0.001). Fractionation differed as well with medians of 5 (central) and 3 (peripheral) fractions (p < 0.001). In the Kaplan–Meier analysis, 3-year actuarial overall survival was 29 % (central) and 51 % (peripheral; p = 0.004) and freedom from local progression was 52 % (central) and 84 % (peripheral; p < 0.001). Toxicity after treatment of central tumors was low with no grade III/IV and one grade V event. Mortality rates were 0 and 1 % after 30 and 60 days, respectively.

Conclusion

Local tumor control in patients treated with SBRT for centrally located, early-stage NSCLC was favorable, provided ablative radiation doses were prescribed. This was, however, not the case in the majority of patients, possibly due to concerns about treatment-related toxicity. Reported toxicity was low, but prospective trials are needed to resolve the existing uncertainties and to establish safe high-dose regimens for this cohort of patients.

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Title: Stereotactic body radiotherapy for centrally located stage I NSCLC
A multicenter analysis
Authors: Daniel H. Schanne, M.D.
Ursula Nestle, M.D., Ph.D.
Michael Allgäuer, M.D.
Nicolaus Andratschke, M.D., Ph.D.
Steffen Appold, M.D.
Ute Dieckmann, M.D.
Iris Ernst, M.D.
Ute Ganswindt, M.D.
Anca L. Grosu, M.D., Ph.D.
Richard Holy, M.D.
Michael Molls, M.D., Ph.D.
Meinhard Nevinny-Stickel, M.D., Ph.D.
Sabine Semrau, M.D.
Florian Sterzing, M.D.
Andrea Wittig, M.D., Ph.D.
Matthias Guckenberger, M.D., Ph.D.
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 2/2015
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-014-0739-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Stereotactic body radiotherapy for centrally located stage I NSCLC

A multicenter analysis

Abstract

Purpose

Methods and materials

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusion

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