Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer: A Multi-institutional Analysis

Vivek Verma, Valerie K. Shostrom, Weining Zhen, Mutian Zhang, Steve E. Braunstein, John Holland, Christopher L. Hallemeier, Matthew M. Harkenrider, Adrian Iskhanian, Salma K. Jabbour, Albert Attia, Percy Lee, Kyle Wang, Roy H. Decker, Ronald C. McGarry, Charles B. Simone

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Abstract

Purpose To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. Methods Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. Results Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05). Conclusions From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.

Original languageEnglish (US)
Pages (from-to)778-785
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume97
Issue number4
DOIs
StatePublished - Mar 15 2017

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Non-Small Cell Lung Carcinoma
fractionation
toxicity
lungs
radiation therapy
Radiotherapy
tumors
cancer
grade
Neoplasms
Radiation Pneumonitis
Therapeutics
terminology
Terminology
stratification
lesions
Lung
radiation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer : A Multi-institutional Analysis. / Verma, Vivek; Shostrom, Valerie K.; Zhen, Weining; Zhang, Mutian; Braunstein, Steve E.; Holland, John; Hallemeier, Christopher L.; Harkenrider, Matthew M.; Iskhanian, Adrian; Jabbour, Salma K.; Attia, Albert; Lee, Percy; Wang, Kyle; Decker, Roy H.; McGarry, Ronald C.; Simone, Charles B.

In: International Journal of Radiation Oncology Biology Physics, Vol. 97, No. 4, 15.03.2017, p. 778-785.

Research output: Contribution to journalArticle

Verma, V, Shostrom, VK, Zhen, W, Zhang, M, Braunstein, SE, Holland, J, Hallemeier, CL, Harkenrider, MM, Iskhanian, A, Jabbour, SK, Attia, A, Lee, P, Wang, K, Decker, RH, McGarry, RC & Simone, CB 2017, 'Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer: A Multi-institutional Analysis', International Journal of Radiation Oncology Biology Physics, vol. 97, no. 4, pp. 778-785. https://doi.org/10.1016/j.ijrobp.2016.11.049
Verma, Vivek ; Shostrom, Valerie K. ; Zhen, Weining ; Zhang, Mutian ; Braunstein, Steve E. ; Holland, John ; Hallemeier, Christopher L. ; Harkenrider, Matthew M. ; Iskhanian, Adrian ; Jabbour, Salma K. ; Attia, Albert ; Lee, Percy ; Wang, Kyle ; Decker, Roy H. ; McGarry, Ronald C. ; Simone, Charles B. / Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer : A Multi-institutional Analysis. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 97, No. 4. pp. 778-785.
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abstract = "Purpose To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. Methods Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. Results Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25{\%}) and 6 (7{\%}) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9{\%} and 4{\%}, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7{\%} vs 43{\%}, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05). Conclusions From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.",
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T2 - A Multi-institutional Analysis

AU - Verma, Vivek

AU - Shostrom, Valerie K.

AU - Zhen, Weining

AU - Zhang, Mutian

AU - Braunstein, Steve E.

AU - Holland, John

AU - Hallemeier, Christopher L.

AU - Harkenrider, Matthew M.

AU - Iskhanian, Adrian

AU - Jabbour, Salma K.

AU - Attia, Albert

AU - Lee, Percy

AU - Wang, Kyle

AU - Decker, Roy H.

AU - McGarry, Ronald C.

AU - Simone, Charles B.

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N2 - Purpose To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. Methods Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. Results Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05). Conclusions From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.

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