Stereotactic ablative radiotherapy: A potentially curable approach to early stage multiple primary lung cancer

Authors

  • Joe Y. Chang MD, PhD,

    Corresponding author
    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Corresponding author: Joe Y. Chang, MD, PhD, Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; Fax: (713) 563-2331; jychang@mdanderson.org

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  • Yung-Hsien Liu MD,

    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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    • The second and third authors contributed equally to this work.

  • Zhengfei Zhu MD, PhD,

    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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    • The second and third authors contributed equally to this work.

  • James W. Welsh MD,

    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Daniel R. Gomez MD,

    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Ritsuko Komaki MD,

    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Jack A. Roth MD,

    1. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Stephen G. Swisher MD

    1. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • We thank all members of the Thoracic Radiation Oncology section in the Division of Radiation Oncology for their help and Ms. Christine Wogan for editorial assistance.

Abstract

BACKGROUND

Surgical resection has been the standard treatment for early stage multiple primary lung cancer (MPLC). However, a significant proportion of patients with MPLC cannot undergo surgery. For this report, the authors explored the role of stereotactic ablative radiotherapy (SABR) for patients with MPLC.

METHODS

Patients with MPLC who received SABR (50 grays [Gy] in 4 fractions or 70 Gy in 10 fractions) for the second tumor were reviewed. Four-dimensional, computed tomography-based, planning/volumetric image-guided treatment was used for all patients. Treatment outcomes/toxicities were analyzed.

RESULTS

For the 101 patients who received SABR, at a median follow-up of 36 months and with a median overall survival (OS) of 46 months, the 2-year and 4-year in-field local control rates were 97.4% and 95.7%, respectively. The 2-year and 4-year OS rates were 73.2% and 47.5%, respectively; and the progression-free survival (PFS) rates were 67% and 58%, respectively. Patients who had metachronous tumors had better OS and PFS than patients who had synchronous tumors (2-year OS: 80.6% metachronous vs 61.5% synchronous; 4-year OS: 52.7% vs 39.7%, respectively; P = .047; 2-year PFS: 84.7% vs 49.4%, respectively; 4-year PFS: 75.6% vs 30.4%, respectively; P = .0001). For patients who either underwent surgery or received SABR for an index tumor, the incidence of grade ≥3 radiation pneumonitis was 3% (2 of 71 patients); however, this increased to 17% (5 of 30 patients) for those who received conventional radiotherapy for an index tumor. Other grade ≥3 toxicities included grade 3 chest wall pain (3 of 101 patients; 3%) and grade 3 skin toxicity (1 of 101 patients; 1%).

CONCLUSIONS

SABR achieves promising long-term tumor control and survival and may be a potential curative treatment for early stage MPLC. Cancer 2013;119:3402–10. © 2013 American Cancer Society.

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