Lung Cancer

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TU_28_3597 - Long-Term Survival of Stereotactic Body Radiation Therapy for Central, Ultracentral, and Para-Mediastinal Non-Small Cell Lung Cancer

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Long-Term Survival of Stereotactic Body Radiation Therapy for Central, Ultracentral, and Para-Mediastinal Non-Small Cell Lung Cancer
C. He1,2, L. Y. Mei3, A. Cerra-Franco4, K. Shiue4, R. Liu1,2, M. Langer1, R. C. Zellars4, T. Lautenschlaeger4, and F. M. Kong4; 1Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, indianapolis, IN, 2Department of Thoracic Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, zhengzhou, China, 3West China Hospital of Sichuan University, Chengdu, China, 4Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN

Purpose/Objective(s): Safety of tereotactic body radiation therapy (SBRT) remains controversial for centrally located non-small cell lung cancer (NSCLC). Our earlier trial eported high mortality for a 3-fraction regimen. RTOG813 reported safety for a 5-fraction regimen, but a recent Nordic trial report concerning massive bleeding for 8-fraction regimen. The objective of this study is to report long-term survival and toxicity of SBRT for NSCLC classified as central (C), ultracentral (UC), paramediastinal (PM), or peripheral disease (P).

Materials/Methods: This retrospective study analyzed patients with NSCLC who received SBRT between July 2002 and June 2015. The primary and secondary endpoints were overall survival and radiation pneumonitis, respectively. Tumor centrality was defined as per the RTOG 0813 protocol. Centrally located tumors were classified as UC if the PTV overlapped the proximal bronchial tree (PBT) or esophagus, C if located within 2 cm of the PBT and PM if abutting the mediastinal pleural but not meeting criteria for C. Overall survival (OS) was evaluated using the Kaplan-Meier method and significance was tested using log-rank regression.

Results: Of a total 324 SBRT patients with clinically staged T1-T3 N0 NSCLC 67 patients had central (34 C, 16 UC, 17 PM) and 257 had peripheral tumors. The median age was 74 years (range: 50-96 years), and 48% were male. The median follow-up was 59 months (95% CI 49-68). The most common SBRT fraction regimens were 48Gy in 4 fractions, 50Gy in 5 fractions, 50Gy in 5 fractions, and 48Gy in 4 fractions for C, UC, PM and P groups, respectively. The median survival times for C, UC, PM and P were 25, 36, 17 and 32 months, respectively; 3 yr. survival rates were 37.8%,49.2%,29.4, 46.5%, respectively; and 5 yrs survival rates were 29.4%,24.6%, 19.6, 26.4% (P=0.274), respectively. The median PTV volumes were 48.9 cm3 (range 12.5-171.7), 56.7 cm3 (range 6.6-133.7), 63.2 cm3 (range 13.6-228.1), 28.8 cm3 (range 1-237), respectively (P<0.001) for C, UC, PM and P. BED10was 105.6 Gy (range 18.8-151.2), 105.6 Gy (range 100-151.2), 100 Gy (range 85.5-112.5), 120.8 Gy (range 60-244) for C, UC, PM and P groups. (P<0.001), respectively. There was no statistically significant difference in grade 2 or greater pneumonitis among all groups (p>0.05).

Conclusion: Using 48Gy in 4 fractions or 50Gy in 5 fractions, patients with central, ultracentral, and paramediastinum lung tumors treated with SBRT experienced good outcomes and few lung toxicities, similar to patients with peripheral lung tumors.

Author Disclosure: C. He: None. L.Y. Mei: None. A. Cerra-Franco: None. R. Liu: None. M. Langer: None. R. Zellars: Board Member; Indiana University Health Physicians. T. Lautenschlaeger: None. F.(. Kong: Research Grant; Varian, NCI/NIH. Founding President and Board of Director; Sino-American Network for Therapeutic Radiation On. President 2015; American Association of Women Radiologists (AAWR). President 2012-2013; Association for Chinese Professors. Founding Board Member; Sino-American Network for Therapeutic Radiology.

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