Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location

Caitlin A Schonewolf; Marina Heskel; Abigail Doucette; Sunil Singhal; Melissa A Frick; Eric P Xanthopoulos; Michael N Corradetti; Joseph S Friedberg; Taine T Pechet; John P Christodouleas; William Levin; Abigail Berman; Keith A Cengel; Vivek Verma; Stephen M Hahn; John C Kucharczuk; Ramesh Rengan; Charles B Simone

doi:10.1016/j.cllc.2018.09.004

Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location

Caitlin A Schonewolf, Marina Heskel, Abigail Doucette, Sunil Singhal, Melissa A Frick, Eric P Xanthopoulos, Michael N Corradetti, Joseph S Friedberg, Taine T Pechet, John P Christodouleas, William Levin, Abigail Berman, Keith A Cengel, Vivek Verma, Stephen M Hahn, John C Kucharczuk, Ramesh Rengan, Charles B Simone

Radiation Oncology

Research output: Contribution to journal › Article › peer-review

35 Scopus citations

Abstract

BACKGROUND: Stereotactic body radiation therapy (SBRT) is standard for medically inoperable stage I non-small-cell lung cancer (NSCLC) and is emerging as a surgical alternative in operable patients. However, limited long-term outcomes data exist, particularly according to operability. We hypothesized long-term local control (LC) and cancer-specific survival (CSS) would not differ by fractionation schedule, tumor size or location, or operability status, but overall survival (OS) would be higher for operable patients.

PATIENTS AND METHODS: All consecutive patients with stage I (cT1-2aN0M0) NSCLC treated with SBRT from June 2009 to July 2013 were assessed. Thoracic surgeon evaluation determined operability. Local failure was defined as growth following initial tumor shrinkage or progression on consecutive scans. LC, CSS, and OS were calculated using Cox proportional hazards regression.

RESULTS: A total of 186 patients (204 lesions) were analyzed. Most patients were inoperable (82%) with Eastern Cooperative Oncology Group performance status of 1 (59%) or 2 (26%). All lesions received biological effective doses ≥ 100 Gy most commonly (94%) in 3 to 5 fractions. The median follow-up was 4.0 years. LC at 2 and 5 years were 95.6% (95% confidence interval, 92%-99%) and 93.7% (95% confidence interval, 90%-98%), respectively. Compared with operable patients, inoperable patients did not have significant differences in 5-year LC (93.1% vs. 96.7%; P = .49), nodal failure (31.4% vs. 11.0%; P = .12), distant failure (12.2% vs. 10.4%; P = .98), or CSS (80.6% vs. 91.0%; P = .45) but trended towards worse OS (34.2% vs. 45.3%; P = .068). Tumor size, location, and fractionation did not significantly influence outcomes.

CONCLUSIONS: SBRT has excellent, durable LC and CSS rates for early-stage NSCLC, although inoperable patients had somewhat lower OS than operable patients, likely owing to greater comorbidities.

Original language	English
Pages (from-to)	e63-e71
Journal	Clinical Lung Cancer
Volume	20
Issue number	1
DOIs	https://doi.org/10.1016/j.cllc.2018.09.004
State	Published - Dec 2019

Keywords

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/mortality
Dose Fractionation, Radiation
Female
Follow-Up Studies
Humans
Lung Neoplasms/mortality
Male
Middle Aged
Neoplasm Staging
Radiosurgery
Survival Analysis
Treatment Outcome
Tumor Burden

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.cllc.2018.09.004

Fingerprint

Dive into the research topics of 'Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location'. Together they form a unique fingerprint.

Cite this

Schonewolf, C. A., Heskel, M., Doucette, A., Singhal, S., Frick, M. A., Xanthopoulos, E. P., Corradetti, M. N., Friedberg, J. S., Pechet, T. T., Christodouleas, J. P., Levin, W., Berman, A., Cengel, K. A., Verma, V., Hahn, S. M., Kucharczuk, J. C., Rengan, R., & Simone, C. B. (2019). Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location. Clinical Lung Cancer, 20(1), e63-e71. https://doi.org/10.1016/j.cllc.2018.09.004

@article{cc99ba0a11ef4a5dba2c26dfeb977299,

title = "Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location",

abstract = "BACKGROUND: Stereotactic body radiation therapy (SBRT) is standard for medically inoperable stage I non-small-cell lung cancer (NSCLC) and is emerging as a surgical alternative in operable patients. However, limited long-term outcomes data exist, particularly according to operability. We hypothesized long-term local control (LC) and cancer-specific survival (CSS) would not differ by fractionation schedule, tumor size or location, or operability status, but overall survival (OS) would be higher for operable patients.PATIENTS AND METHODS: All consecutive patients with stage I (cT1-2aN0M0) NSCLC treated with SBRT from June 2009 to July 2013 were assessed. Thoracic surgeon evaluation determined operability. Local failure was defined as growth following initial tumor shrinkage or progression on consecutive scans. LC, CSS, and OS were calculated using Cox proportional hazards regression.RESULTS: A total of 186 patients (204 lesions) were analyzed. Most patients were inoperable (82%) with Eastern Cooperative Oncology Group performance status of 1 (59%) or 2 (26%). All lesions received biological effective doses ≥ 100 Gy most commonly (94%) in 3 to 5 fractions. The median follow-up was 4.0 years. LC at 2 and 5 years were 95.6% (95% confidence interval, 92%-99%) and 93.7% (95% confidence interval, 90%-98%), respectively. Compared with operable patients, inoperable patients did not have significant differences in 5-year LC (93.1% vs. 96.7%; P = .49), nodal failure (31.4% vs. 11.0%; P = .12), distant failure (12.2% vs. 10.4%; P = .98), or CSS (80.6% vs. 91.0%; P = .45) but trended towards worse OS (34.2% vs. 45.3%; P = .068). Tumor size, location, and fractionation did not significantly influence outcomes.CONCLUSIONS: SBRT has excellent, durable LC and CSS rates for early-stage NSCLC, although inoperable patients had somewhat lower OS than operable patients, likely owing to greater comorbidities.",

keywords = "Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung/mortality, Dose Fractionation, Radiation, Female, Follow-Up Studies, Humans, Lung Neoplasms/mortality, Male, Middle Aged, Neoplasm Staging, Radiosurgery, Survival Analysis, Treatment Outcome, Tumor Burden",

author = "Schonewolf, {Caitlin A} and Marina Heskel and Abigail Doucette and Sunil Singhal and Frick, {Melissa A} and Xanthopoulos, {Eric P} and Corradetti, {Michael N} and Friedberg, {Joseph S} and Pechet, {Taine T} and Christodouleas, {John P} and William Levin and Abigail Berman and Cengel, {Keith A} and Vivek Verma and Hahn, {Stephen M} and Kucharczuk, {John C} and Ramesh Rengan and Simone, {Charles B}",

year = "2019",

month = dec,

doi = "10.1016/j.cllc.2018.09.004",

language = "English",

volume = "20",

pages = "e63--e71",

journal = "Clinical Lung Cancer",

issn = "1525-7304",

publisher = "Elsevier",

number = "1",

}

Schonewolf, CA, Heskel, M, Doucette, A, Singhal, S, Frick, MA, Xanthopoulos, EP, Corradetti, MN, Friedberg, JS, Pechet, TT, Christodouleas, JP, Levin, W, Berman, A, Cengel, KA, Verma, V, Hahn, SM, Kucharczuk, JC, Rengan, R & Simone, CB 2019, 'Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location', Clinical Lung Cancer, vol. 20, no. 1, pp. e63-e71. https://doi.org/10.1016/j.cllc.2018.09.004

Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location. / Schonewolf, Caitlin A; Heskel, Marina; Doucette, Abigail et al.
In: Clinical Lung Cancer, Vol. 20, No. 1, 12.2019, p. e63-e71.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer

T2 - Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location

AU - Schonewolf, Caitlin A

AU - Heskel, Marina

AU - Doucette, Abigail

AU - Singhal, Sunil

AU - Frick, Melissa A

AU - Xanthopoulos, Eric P

AU - Corradetti, Michael N

AU - Friedberg, Joseph S

AU - Pechet, Taine T

AU - Christodouleas, John P

AU - Levin, William

AU - Berman, Abigail

AU - Cengel, Keith A

AU - Verma, Vivek

AU - Hahn, Stephen M

AU - Kucharczuk, John C

AU - Rengan, Ramesh

AU - Simone, Charles B

PY - 2019/12

Y1 - 2019/12

N2 - BACKGROUND: Stereotactic body radiation therapy (SBRT) is standard for medically inoperable stage I non-small-cell lung cancer (NSCLC) and is emerging as a surgical alternative in operable patients. However, limited long-term outcomes data exist, particularly according to operability. We hypothesized long-term local control (LC) and cancer-specific survival (CSS) would not differ by fractionation schedule, tumor size or location, or operability status, but overall survival (OS) would be higher for operable patients.PATIENTS AND METHODS: All consecutive patients with stage I (cT1-2aN0M0) NSCLC treated with SBRT from June 2009 to July 2013 were assessed. Thoracic surgeon evaluation determined operability. Local failure was defined as growth following initial tumor shrinkage or progression on consecutive scans. LC, CSS, and OS were calculated using Cox proportional hazards regression.RESULTS: A total of 186 patients (204 lesions) were analyzed. Most patients were inoperable (82%) with Eastern Cooperative Oncology Group performance status of 1 (59%) or 2 (26%). All lesions received biological effective doses ≥ 100 Gy most commonly (94%) in 3 to 5 fractions. The median follow-up was 4.0 years. LC at 2 and 5 years were 95.6% (95% confidence interval, 92%-99%) and 93.7% (95% confidence interval, 90%-98%), respectively. Compared with operable patients, inoperable patients did not have significant differences in 5-year LC (93.1% vs. 96.7%; P = .49), nodal failure (31.4% vs. 11.0%; P = .12), distant failure (12.2% vs. 10.4%; P = .98), or CSS (80.6% vs. 91.0%; P = .45) but trended towards worse OS (34.2% vs. 45.3%; P = .068). Tumor size, location, and fractionation did not significantly influence outcomes.CONCLUSIONS: SBRT has excellent, durable LC and CSS rates for early-stage NSCLC, although inoperable patients had somewhat lower OS than operable patients, likely owing to greater comorbidities.

AB - BACKGROUND: Stereotactic body radiation therapy (SBRT) is standard for medically inoperable stage I non-small-cell lung cancer (NSCLC) and is emerging as a surgical alternative in operable patients. However, limited long-term outcomes data exist, particularly according to operability. We hypothesized long-term local control (LC) and cancer-specific survival (CSS) would not differ by fractionation schedule, tumor size or location, or operability status, but overall survival (OS) would be higher for operable patients.PATIENTS AND METHODS: All consecutive patients with stage I (cT1-2aN0M0) NSCLC treated with SBRT from June 2009 to July 2013 were assessed. Thoracic surgeon evaluation determined operability. Local failure was defined as growth following initial tumor shrinkage or progression on consecutive scans. LC, CSS, and OS were calculated using Cox proportional hazards regression.RESULTS: A total of 186 patients (204 lesions) were analyzed. Most patients were inoperable (82%) with Eastern Cooperative Oncology Group performance status of 1 (59%) or 2 (26%). All lesions received biological effective doses ≥ 100 Gy most commonly (94%) in 3 to 5 fractions. The median follow-up was 4.0 years. LC at 2 and 5 years were 95.6% (95% confidence interval, 92%-99%) and 93.7% (95% confidence interval, 90%-98%), respectively. Compared with operable patients, inoperable patients did not have significant differences in 5-year LC (93.1% vs. 96.7%; P = .49), nodal failure (31.4% vs. 11.0%; P = .12), distant failure (12.2% vs. 10.4%; P = .98), or CSS (80.6% vs. 91.0%; P = .45) but trended towards worse OS (34.2% vs. 45.3%; P = .068). Tumor size, location, and fractionation did not significantly influence outcomes.CONCLUSIONS: SBRT has excellent, durable LC and CSS rates for early-stage NSCLC, although inoperable patients had somewhat lower OS than operable patients, likely owing to greater comorbidities.

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Non-Small-Cell Lung/mortality

KW - Dose Fractionation, Radiation

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lung Neoplasms/mortality

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Radiosurgery

KW - Survival Analysis

KW - Treatment Outcome

KW - Tumor Burden

U2 - 10.1016/j.cllc.2018.09.004

DO - 10.1016/j.cllc.2018.09.004

M3 - Article

C2 - 30337269

SN - 1525-7304

VL - 20

SP - e63-e71

JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

IS - 1

ER -

Schonewolf CA, Heskel M, Doucette A, Singhal S, Frick MA, Xanthopoulos EP et al. Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non-small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location. Clinical Lung Cancer. 2019 Dec;20(1):e63-e71. doi: 10.1016/j.cllc.2018.09.004