Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors

Vivek Verma, Valerie K. Shostrom, Sameera S. Kumar, Weining Zhen, Christopher L. Hallemeier, Steve E. Braunstein, John Holland, Matthew M. Harkenrider, Adrian S. Iskhanian, Hanmanth J. Neboori, Salma K. Jabbour, Albert Attia, Percy Lee, Fiori Alite, Joshua M. Walker, John M. Stahl, Kyle Wang, Brian S. Bingham, Christina Hadzitheodorou, Roy H. Decker & 2 others Ronald C. Mcgarry, Charles B. Simone

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non–small cell lung cancer (NSCLC) measuring < 5 cm, but its use among patients with tumors measuring ≥5 cm is considerably less defined, with the existing literature limited to small, single-institution reports. The current multi-institutional study reported outcomes evaluating the largest such population reported to date. METHODS: Clinical/treatment characteristics, outcomes, toxicities, and patterns of failure were assessed in patients with primary NSCLC measuring ≥5 cm without evidence of distant/lymph node metastasis who underwent SBRT using ≤5 fractions. Statistics included Kaplan-Meier survival analyses and univariate/multivariate Cox proportional hazards models. RESULTS: A total of 92 patients treated from 2004 through 2016 were analyzed from 12 institutions. The median follow-up was 12 months (15 months in survivors). The median age and tumor size among the patients were 73 years (range, 50-95 years) and 5.4 cm (range, 5.0-7.5 cm), respectively. The median dose/fractionation was 50 Gray/5 fractions. The actuarial local control rates at 1 year and 2 years were 95.7% and 73.2%, respectively. The disease-free survival rate was 72.1% and 53.5%, respectively, at 1 year and 2 years. The 1-year and 2-year disease-specific survival rates were 95.5% and 78.6%, respectively. The median, 1-year, and 2-year overall survival rates were 21.4 months, 76.2%, and 46.4%, respectively. On multivariate analysis, lung cancer history and pre-SBRT positron emission tomography maximum standardized uptake value were found to be associated with overall survival. Posttreatment failures were most commonly distant (33% of all disease recurrences), followed by local (26%) and those occurring elsewhere in the lung (23%). Three patients had isolated local failures. Grade 3 to 4 toxicities included 1 case (1%) and 4 cases (4%) of grade 3 dermatitis and radiation pneumonitis, respectively (toxicities were graded according to the Common Terminology Criteria for Adverse Events [version 4.0]). Grades 2 to 5 radiation pneumonitis occurred in 11% of patients. One patient with a tumor measuring 7.5 cm and a smoking history of 150 pack-years died of radiation pneumonitis. CONCLUSIONS: The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688–696.

Original languageEnglish (US)
Pages (from-to)688-696
Number of pages9
JournalCancer
Volume123
Issue number4
DOIs
StatePublished - Feb 15 2017

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Radiosurgery
Lung
Radiation Pneumonitis
Neoplasms
Non-Small Cell Lung Carcinoma
Survival Rate
Dose Fractionation
Kaplan-Meier Estimate
Dermatitis
Standard of Care
Survival Analysis
Proportional Hazards Models
Terminology
Positron-Emission Tomography
Disease-Free Survival
Survivors
Lung Neoplasms
Multivariate Analysis
Lymph Nodes
Smoking

Keywords

  • chemotherapy
  • image-guided radiotherapy
  • non–small cell lung cancer
  • stereotactic body radiotherapy
  • toxicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Verma, V., Shostrom, V. K., Kumar, S. S., Zhen, W., Hallemeier, C. L., Braunstein, S. E., ... Simone, C. B. (2017). Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors. Cancer, 123(4), 688-696. https://doi.org/10.1002/cncr.30375

Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors. / Verma, Vivek; Shostrom, Valerie K.; Kumar, Sameera S.; Zhen, Weining; Hallemeier, Christopher L.; Braunstein, Steve E.; Holland, John; Harkenrider, Matthew M.; Iskhanian, Adrian S.; Neboori, Hanmanth J.; Jabbour, Salma K.; Attia, Albert; Lee, Percy; Alite, Fiori; Walker, Joshua M.; Stahl, John M.; Wang, Kyle; Bingham, Brian S.; Hadzitheodorou, Christina; Decker, Roy H.; Mcgarry, Ronald C.; Simone, Charles B.

In: Cancer, Vol. 123, No. 4, 15.02.2017, p. 688-696.

Research output: Contribution to journalArticle

Verma, V, Shostrom, VK, Kumar, SS, Zhen, W, Hallemeier, CL, Braunstein, SE, Holland, J, Harkenrider, MM, Iskhanian, AS, Neboori, HJ, Jabbour, SK, Attia, A, Lee, P, Alite, F, Walker, JM, Stahl, JM, Wang, K, Bingham, BS, Hadzitheodorou, C, Decker, RH, Mcgarry, RC & Simone, CB 2017, 'Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors', Cancer, vol. 123, no. 4, pp. 688-696. https://doi.org/10.1002/cncr.30375
Verma, Vivek ; Shostrom, Valerie K. ; Kumar, Sameera S. ; Zhen, Weining ; Hallemeier, Christopher L. ; Braunstein, Steve E. ; Holland, John ; Harkenrider, Matthew M. ; Iskhanian, Adrian S. ; Neboori, Hanmanth J. ; Jabbour, Salma K. ; Attia, Albert ; Lee, Percy ; Alite, Fiori ; Walker, Joshua M. ; Stahl, John M. ; Wang, Kyle ; Bingham, Brian S. ; Hadzitheodorou, Christina ; Decker, Roy H. ; Mcgarry, Ronald C. ; Simone, Charles B. / Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors. In: Cancer. 2017 ; Vol. 123, No. 4. pp. 688-696.
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abstract = "BACKGROUND: Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non–small cell lung cancer (NSCLC) measuring < 5 cm, but its use among patients with tumors measuring ≥5 cm is considerably less defined, with the existing literature limited to small, single-institution reports. The current multi-institutional study reported outcomes evaluating the largest such population reported to date. METHODS: Clinical/treatment characteristics, outcomes, toxicities, and patterns of failure were assessed in patients with primary NSCLC measuring ≥5 cm without evidence of distant/lymph node metastasis who underwent SBRT using ≤5 fractions. Statistics included Kaplan-Meier survival analyses and univariate/multivariate Cox proportional hazards models. RESULTS: A total of 92 patients treated from 2004 through 2016 were analyzed from 12 institutions. The median follow-up was 12 months (15 months in survivors). The median age and tumor size among the patients were 73 years (range, 50-95 years) and 5.4 cm (range, 5.0-7.5 cm), respectively. The median dose/fractionation was 50 Gray/5 fractions. The actuarial local control rates at 1 year and 2 years were 95.7{\%} and 73.2{\%}, respectively. The disease-free survival rate was 72.1{\%} and 53.5{\%}, respectively, at 1 year and 2 years. The 1-year and 2-year disease-specific survival rates were 95.5{\%} and 78.6{\%}, respectively. The median, 1-year, and 2-year overall survival rates were 21.4 months, 76.2{\%}, and 46.4{\%}, respectively. On multivariate analysis, lung cancer history and pre-SBRT positron emission tomography maximum standardized uptake value were found to be associated with overall survival. Posttreatment failures were most commonly distant (33{\%} of all disease recurrences), followed by local (26{\%}) and those occurring elsewhere in the lung (23{\%}). Three patients had isolated local failures. Grade 3 to 4 toxicities included 1 case (1{\%}) and 4 cases (4{\%}) of grade 3 dermatitis and radiation pneumonitis, respectively (toxicities were graded according to the Common Terminology Criteria for Adverse Events [version 4.0]). Grades 2 to 5 radiation pneumonitis occurred in 11{\%} of patients. One patient with a tumor measuring 7.5 cm and a smoking history of 150 pack-years died of radiation pneumonitis. CONCLUSIONS: The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688–696.",
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author = "Vivek Verma and Shostrom, {Valerie K.} and Kumar, {Sameera S.} and Weining Zhen and Hallemeier, {Christopher L.} and Braunstein, {Steve E.} and John Holland and Harkenrider, {Matthew M.} and Iskhanian, {Adrian S.} and Neboori, {Hanmanth J.} and Jabbour, {Salma K.} and Albert Attia and Percy Lee and Fiori Alite and Walker, {Joshua M.} and Stahl, {John M.} and Kyle Wang and Bingham, {Brian S.} and Christina Hadzitheodorou and Decker, {Roy H.} and Mcgarry, {Ronald C.} and Simone, {Charles B.}",
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TY - JOUR

T1 - Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non–small cell lung tumors

AU - Verma, Vivek

AU - Shostrom, Valerie K.

AU - Kumar, Sameera S.

AU - Zhen, Weining

AU - Hallemeier, Christopher L.

AU - Braunstein, Steve E.

AU - Holland, John

AU - Harkenrider, Matthew M.

AU - Iskhanian, Adrian S.

AU - Neboori, Hanmanth J.

AU - Jabbour, Salma K.

AU - Attia, Albert

AU - Lee, Percy

AU - Alite, Fiori

AU - Walker, Joshua M.

AU - Stahl, John M.

AU - Wang, Kyle

AU - Bingham, Brian S.

AU - Hadzitheodorou, Christina

AU - Decker, Roy H.

AU - Mcgarry, Ronald C.

AU - Simone, Charles B.

PY - 2017/2/15

Y1 - 2017/2/15

N2 - BACKGROUND: Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non–small cell lung cancer (NSCLC) measuring < 5 cm, but its use among patients with tumors measuring ≥5 cm is considerably less defined, with the existing literature limited to small, single-institution reports. The current multi-institutional study reported outcomes evaluating the largest such population reported to date. METHODS: Clinical/treatment characteristics, outcomes, toxicities, and patterns of failure were assessed in patients with primary NSCLC measuring ≥5 cm without evidence of distant/lymph node metastasis who underwent SBRT using ≤5 fractions. Statistics included Kaplan-Meier survival analyses and univariate/multivariate Cox proportional hazards models. RESULTS: A total of 92 patients treated from 2004 through 2016 were analyzed from 12 institutions. The median follow-up was 12 months (15 months in survivors). The median age and tumor size among the patients were 73 years (range, 50-95 years) and 5.4 cm (range, 5.0-7.5 cm), respectively. The median dose/fractionation was 50 Gray/5 fractions. The actuarial local control rates at 1 year and 2 years were 95.7% and 73.2%, respectively. The disease-free survival rate was 72.1% and 53.5%, respectively, at 1 year and 2 years. The 1-year and 2-year disease-specific survival rates were 95.5% and 78.6%, respectively. The median, 1-year, and 2-year overall survival rates were 21.4 months, 76.2%, and 46.4%, respectively. On multivariate analysis, lung cancer history and pre-SBRT positron emission tomography maximum standardized uptake value were found to be associated with overall survival. Posttreatment failures were most commonly distant (33% of all disease recurrences), followed by local (26%) and those occurring elsewhere in the lung (23%). Three patients had isolated local failures. Grade 3 to 4 toxicities included 1 case (1%) and 4 cases (4%) of grade 3 dermatitis and radiation pneumonitis, respectively (toxicities were graded according to the Common Terminology Criteria for Adverse Events [version 4.0]). Grades 2 to 5 radiation pneumonitis occurred in 11% of patients. One patient with a tumor measuring 7.5 cm and a smoking history of 150 pack-years died of radiation pneumonitis. CONCLUSIONS: The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688–696.

AB - BACKGROUND: Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non–small cell lung cancer (NSCLC) measuring < 5 cm, but its use among patients with tumors measuring ≥5 cm is considerably less defined, with the existing literature limited to small, single-institution reports. The current multi-institutional study reported outcomes evaluating the largest such population reported to date. METHODS: Clinical/treatment characteristics, outcomes, toxicities, and patterns of failure were assessed in patients with primary NSCLC measuring ≥5 cm without evidence of distant/lymph node metastasis who underwent SBRT using ≤5 fractions. Statistics included Kaplan-Meier survival analyses and univariate/multivariate Cox proportional hazards models. RESULTS: A total of 92 patients treated from 2004 through 2016 were analyzed from 12 institutions. The median follow-up was 12 months (15 months in survivors). The median age and tumor size among the patients were 73 years (range, 50-95 years) and 5.4 cm (range, 5.0-7.5 cm), respectively. The median dose/fractionation was 50 Gray/5 fractions. The actuarial local control rates at 1 year and 2 years were 95.7% and 73.2%, respectively. The disease-free survival rate was 72.1% and 53.5%, respectively, at 1 year and 2 years. The 1-year and 2-year disease-specific survival rates were 95.5% and 78.6%, respectively. The median, 1-year, and 2-year overall survival rates were 21.4 months, 76.2%, and 46.4%, respectively. On multivariate analysis, lung cancer history and pre-SBRT positron emission tomography maximum standardized uptake value were found to be associated with overall survival. Posttreatment failures were most commonly distant (33% of all disease recurrences), followed by local (26%) and those occurring elsewhere in the lung (23%). Three patients had isolated local failures. Grade 3 to 4 toxicities included 1 case (1%) and 4 cases (4%) of grade 3 dermatitis and radiation pneumonitis, respectively (toxicities were graded according to the Common Terminology Criteria for Adverse Events [version 4.0]). Grades 2 to 5 radiation pneumonitis occurred in 11% of patients. One patient with a tumor measuring 7.5 cm and a smoking history of 150 pack-years died of radiation pneumonitis. CONCLUSIONS: The results of the current study, which is the largest study of patients with NSCLC measuring ≥5 cm reported to date, indicate that SBRT is a safe and efficacious option. Cancer 2017;123:688–696.

KW - chemotherapy

KW - image-guided radiotherapy

KW - non–small cell lung cancer

KW - stereotactic body radiotherapy

KW - toxicity

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