2010 Annual Meeting Abstracts
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Stereotactic Radiosurgery Provides Acceptable Local Control for Medically Inoperable Non-small Cell Lung Cancer
Michael P. Robich1, *Stuart M. Berman1, *Jeffrey J. Siracuse1, *Shiva Gautam1, *Sidhu P Gangadharan1, *Michael S. Kent1, Malcolm M. DeCamp2
1Beth Israel Deaconess Medical Center, Boston, MA;2Feinberg School of Medicine, Northwestern University, Chicago, IL
Objective: Many patients with primary lung cancer have co-morbidities that preclude safe surgical resection. Stereotactic body radiotherapy (SBRT) is a potential therapeutic alternative for medically inoperable patients.
Design: Retrospective review
Setting: Tertiary care referral center
Patients: All patients with primary lung cancer referred for SBRT. Seventy-five patients (mean age 75 years, range 40-91) from 11/2006 to 12/2008 were evaluated by a multi-disciplinary team. Patients with well-marginated lesions, <3cm, in favorable locations underwent radio-frequency ablation (RFA). All SBRT patients were deemed unfit for both surgery and RFA.
Main outcome measures: Survival and disease progression. Patients were staged and followed with PET-CT. Treatment response was assessed by response evaluation criteria in solid tumors (RECIST). Median follow-up was 10.4±2.5 months.
Results: Mean tumor diameter was 2.80±1.54cm. The mean pre-treatment %-predicted FEV1 of treated patients was 54±23% with a mean %-predicted DLCO of 53±3%. Fourteen patients (19%) required supplemental oxygen at baseline. A total of 224±7 separate beam orientations delivered in 3-4 fractions generated a mean biologically equivalent dose (BED) of 123±67 Gy. While complete response was rare (3%), 68% of patients had either a partial response or disease stability at last follow-up. One patient (1%) suffered grade 3/4 radiation pneumonitis requiring hospitalization. Median progression free survival was 18.9±1.1 months. These results reflect adverse selection bias as more favorable lesions were treated with RFA.
Conclusion: SBRT provided medically inoperable lung cancer patients with acceptable local control and progression free survival. SBRT appeared equally efficacious for small and larger tumors regardless of location within the pulmonary parenchyma. Understanding the capabilities of SBRT will allow the surgeon to select the best local treatment modality for marginal or inoperable patients.
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