Stereotactic Body Radiotherapy for Stage I Non-small Cell Lung Cancer: The Importance of Treatment Planning Algorithm and Evaluation of a Tumor Control Probability Model

Publication date: Available online 7 October 2017
Source:Practical Radiation Oncology
Author(s): Nitin Ohri, Wolfgang Tomé, Shalom Kalnicki, Madhur Garg
BackgroundStereotactic body radiotherapy (SBRT) is increasingly used to treat early stage non-small cell lung cancer (NSCLC). A previous report introduced the term size-adjusted biologically effective dose (sBED), which accounts for tumor diameter and biologically effective dose (BED) and may be used to predict the likelihood of local control following SBRT. Here we seek to replicate those findings using a separate dataset.MethodsWe queried the RSSearch® Patient Registry for patients treated with SBRT for stage I NSCLC. Kaplan-Meier survival curves, logrank testing, and Cox proportional hazards modeling were utilized to evaluate tumor diameter, BED, and treatment planning algorithm as predictors of local control. sBED was defined as BED minus 10 times the tumor diameter (in centimeters). Tumor control probability (TCP) modeling was performed to characterize the relationship between sBED and the likelihood of local control two years after SBRT.Results928 patients met inclusion criteria. Median BED was 115.5 Gy, and 59% of patients had T1 tumors. Local control rates following treatments planned using a pencil beam algorithm were inferior to those observed following treatments planned using a Monte Carlo algorithm (89% v. 96% at two years, logrank p = 0.022). In a multivariable Cox model adjusted for tumor diameter and BED, the use of a pencil beam planning algorithm was associated with increased risk of local failure (HR=2.39, 95% CI 1.08–5.29, p=0.032). TCP modeling, restricted to patients treated using a Monte Carlo algorithm, demonstrated that sBED values of 60 Gy, 80 Gy, and 100 Gy yield predicted TCP rates of 91%, 95%, and 97%, respectively.ConclusionUsing a large, multi-institutional database, we found a strong association between treatment planning algorithm and local control rates following SBRT for early stage NSCLC. Size-adjusted BED is a useful tool for predicting the likelihood of local control following SBRT in this setting.



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