Multi-Institutional Experience of Stereotactic Ablative Radiotherapy for Stage I Small Cell Lung Cancer

Publication date: Available online 2 November 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Vivek Verma, Charles B. Simone, Pamela K. Allen, Sameer R. Gajjar, Chirag Shah, Weining Zhen, Matthew M. Harkenrider, Christopher L. Hallemeier, Salma K. Jabbour, Chance L. Matthiesen, Steve E. Braunstein, Percy Lee, Thomas J. Dilling, Bryan G. Allen, Elizabeth M. Nichols, Albert Attia, Jing Zeng, Tithi Biswas, Peter Paximadis, Fen Wang, Joshua M. Walker, John M. Stahl, Megan E. Daly, Roy H. Decker, Russell K. Hales, Henning Willers, Gregory M.M. Videtic, Minesh P. Mehta, Steven H. Lin
PurposeFor inoperable stage I (T1-2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with/without conventionally-fractionated radiotherapy. This multi-institutional cohort study investigated the role of stereotactic ablative radiotherapy (SABR) for this population.MethodsClinical/treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically-confirmed T1-T2N0M0 SCLC. Kaplan-Meier analysis evaluated survival outcomes. Univariate and multivariate analyses identified predictors of outcomes.ResultsFrom 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). Median age and tumor size were 72 years and 2.5cm, respectively. Chemotherapy and prophylactic cranial irradiation (PCI) were delivered in 56% and 23% of cases, respectively. Median SABR dose/fractionation was 50 Gy/5 fractions. One- and 3-year local control (LC) were 97.4% and 96.1%, respectively. Median disease-free survival (DFS) was 49.7 months (58.3% and 53.2% at 1- and 3-years, respectively). Median, 1-year, and 3-year disease-specific survival were 52.3 months, 84.5% and 64.4%, respectively. Median, 1-year, and 3-year overall survival (OS) were 17.8 months, 69.9% and 34.0% respectively. Patients receiving chemotherapy experienced increased median DFS (61.3 vs. 9.0 months, p=0.02) and OS (31.4 vs. 14.3 months, p=0.02). Chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (p=0.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failures were most commonly distant (45.8% of recurrences), followed by nodal (25.0%), and elsewhere lung (20.8%). Median times to each were between 5-7 months.ConclusionsIn the largest report on SABR for T1-2N0 SCLC to date, SABR (≥50Gy) with chemotherapy should be considered a standard option.

Teaser

For inoperable stage I (T1-2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with/without conventionally-fractionated radiotherapy. This multi-institutional cohort study demonstrated that stereotactic ablative radiotherapy together with chemotherapy provide appropriate local control and survival, and should thus be considered to treat these patients.


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