(P108) Stereotactic Body Radiation Therapy for the Treatment of Large (> 5 cm) Primary Non–Small-Cell Carcinoma

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

The use of SBRT for T2bN0 primary NSCLC is a safe, effective, and well-tolerated treatment.

Michael C. Roach, MD, Sana Rehman, MD, Dan Mullen, DDS, Jeff D. Bradley, MD, Cliff G. Robinson, MD; Washington University

PURPOSE: Patients with inoperable large primary non–small-cell lung carcinoma (NSCLC) present a therapeutic challenge, given the concern for radiation delivered to a large volume of the lung. As such, these patients have so far been excluded from most prospective trials of stereotactic body radiation therapy (SBRT). We evaluated the outcomes of SBRT in the treatment of large primary NSCLC at our institution.

MATERIALS AND METHODS: A total of 25 patients with biopsy-proven large NSCLC treated with SBRT alone with definitive intent were identified from an institutional review board (IRB)-approved prospective thoracic SBRT registry. Tumors were defined as large if they were greater than 5 cm in diameter on computed tomography (CT) (American Joint Committee on Cancer [AJCC] T2b or T3). All had positron emission tomography (PET) scans without evidence of nodal metastasis. Patients were treated to 45–60 Gy in three or five fractions. Patients were reviewed for overall survival (OS), local control (LC), progression-free survival (PFS), and toxicity, with survival and control calculated from completion of therapy using the Kaplan-Meier method. Toxicity was graded according to Common Terminology Criteria for Adverse Events version 4.03 (CTCAE v4.03).

RESULTS: Mean follow-up was 21 months (range: 2–83 mo). Median tumor size was 5.5 cm; 23 patients had T2b, and 2 had T3 tumors. Actuarial 2-year OS was 39%, and median survival was 20.1 months. The 2-year PFS was 68%. One patient failed in the mediastinum, two failed locally and in the mediastinum, one failed distantly, and one failed both locally and distantly. Both distant failures occurred in the two patients with T3 tumors. Two patients developed second primaries in different lobes. At 2 years, the actuarial rates of local failure and of distant failure were both 9%. Treatment was well tolerated, with 24% developing any chest wall toxicity (12% grade 1, 8% grade 2, and 4% grade 3). A single patient (4%) developed a rib fracture, and another developed a chest wall ulcer. A single patient (4%) required steroids for pneumonitis.

CONCLUSIONS: The use of SBRT for T2bN0 primary NSCLC is a safe, effective, and well-tolerated treatment.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
Related Videos
Common adverse effects following treatment with lenvatinib plus pembrolizumab in the phase 3 CLEAR study include diarrhea, hypertension, and fatigue, according to Thomas E. Hutson, DO, PharmD, FACP.
Lenvatinib in combination with pembrolizumab appears to raise no new safety signals in patients with advanced clear cell renal cell carcinoma after 4 years of follow-up in the phase 3 CLEAR study.
According to Thomas E. Hutson, DO, PharmD, FACP, 4-year follow-up data from the phase 3 CLEAR study confirm the maintained benefits of lenvatinib plus pembrolizumab in patients with advanced renal cell carcinoma.
Findings from the phase 3 MIRASOL trial support mirvetuximab soravtansine as a standard treatment option for platinum-resistant ovarian cancer, according to Ritu Salani, MD.
Rana R. McKay, MD discusses presentations of interest that were presented at the 2023 Kidney Cancer Research Summit, including a discussion on how PET imaging may identify which patients with renal cell carcinoma may respond to immunotherapy.
A better understanding of tumor biology may be necessary for identifying novel non-immunotherapy–based therapeutic strategies for patients with renal cell carcinoma, according to Rana R. McKay, MD.
Probiotics and other agents targeting fatty acid oxidation are also under evaluation as treatment options for patients with renal cell carcinoma, according to Rana R. McKay, MD.
Other angiogenic agents are also under investigation in renal cell carcinoma, according to Rana McKay, MD, who indicates it will be interesting to see how they compare with belzutifan.
Trastuzumab deruxtecan appears to elicit ‘impressive’ responses among patients with HER2-positive gynecologic cancers regardless of immunohistochemistry in the phase 2 DESTINY-PanTumor02 trial.
Ritu Salani, MD, highlights the possible benefit of a novel targeted therapy and autologous tumor vaccine in patients with platinum-resistant ovarian cancer, and in the maintenance setting after treatment for platinum-sensitive disease.