Local Control After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer

Percy Lee, Billy W. Loo, Tithi Biswas, George X. Ding, Issam M. El Naqa, Andrew Jackson, Feng Ming Kong, Tamara LaCouture, Moyed Miften, Timothy Solberg, Wolfgang A. Tome, An Tai, Ellen Yorke, X. Allen Li

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Numerous dose and fractionation schedules have been used to treat medically inoperable stage I non-small cell lung cancer (NSCLC)with stereotactic body radiation therapy (SBRT)or stereotactic ablative radiation therapy. We evaluated published experiences with SBRT to determine local control (LC)rates as a function of SBRT dose. Methods and Materials: One hundred sixty published articles reporting LC rates after SBRT for stage I NSCLC were identified. Quality of the series was assessed by evaluating the number of patients in the study, homogeneity of the dose regimen, length of follow-up time, and reporting of LC. Clinical data including 1, 2, 3, and 5-year tumor control probabilities for stages T1, T2, and combined T1 and T2 as a function of the biological effective dose were fitted to the linear quadratic, universal survival curve, and regrowth models. Results: Forty-six studies met inclusion criteria. As measured by the goodness of fit χ 2 /ndf, with ndf as the number of degrees of freedom, none of the models were ideal fits for the data. Of the 3 models, the regrowth model provides the best fit to the clinical data. For the regrowth model, the fitting yielded an α-to-β ratio of approximately 25 Gy for T1 tumors, 19 Gy for T2 tumors, and 21 Gy for T1 and T2 combined. To achieve the maximal LC rate, the predicted physical dose schemes when prescribed at the periphery of the planning target volume are 43 ± 1 Gy in 3 fractions, 47 ± 1 Gy in 4 fractions, and 50 ± 1 Gy in 5 fractions for combined T1 and T2 tumors. Conclusions: Early-stage NSCLC is radioresponsive when treated with SBRT or stereotactic ablative radiation therapy. A steep dose-response relationship exists with high rates of durable LC when physical doses of 43-50 Gy are delivered in 3 to 5 fractions.

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Non-Small Cell Lung Carcinoma
lungs
radiation therapy
Radiotherapy
cancer
dosage
tumors
Neoplasms
Dose Fractionation
goodness of fit
schedules
fractionation
homogeneity
planning
Appointments and Schedules
degrees of freedom
inclusions
Survival
curves

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Local Control After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer. / Lee, Percy; Loo, Billy W.; Biswas, Tithi; Ding, George X.; El Naqa, Issam M.; Jackson, Andrew; Kong, Feng Ming; LaCouture, Tamara; Miften, Moyed; Solberg, Timothy; Tome, Wolfgang A.; Tai, An; Yorke, Ellen; Li, X. Allen.

In: International Journal of Radiation Oncology Biology Physics, 01.01.2019.

Research output: Contribution to journalArticle

Lee, P, Loo, BW, Biswas, T, Ding, GX, El Naqa, IM, Jackson, A, Kong, FM, LaCouture, T, Miften, M, Solberg, T, Tome, WA, Tai, A, Yorke, E & Li, XA 2019, 'Local Control After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer', International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2019.03.045
Lee, Percy ; Loo, Billy W. ; Biswas, Tithi ; Ding, George X. ; El Naqa, Issam M. ; Jackson, Andrew ; Kong, Feng Ming ; LaCouture, Tamara ; Miften, Moyed ; Solberg, Timothy ; Tome, Wolfgang A. ; Tai, An ; Yorke, Ellen ; Li, X. Allen. / Local Control After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer. In: International Journal of Radiation Oncology Biology Physics. 2019.
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abstract = "Purpose: Numerous dose and fractionation schedules have been used to treat medically inoperable stage I non-small cell lung cancer (NSCLC)with stereotactic body radiation therapy (SBRT)or stereotactic ablative radiation therapy. We evaluated published experiences with SBRT to determine local control (LC)rates as a function of SBRT dose. Methods and Materials: One hundred sixty published articles reporting LC rates after SBRT for stage I NSCLC were identified. Quality of the series was assessed by evaluating the number of patients in the study, homogeneity of the dose regimen, length of follow-up time, and reporting of LC. Clinical data including 1, 2, 3, and 5-year tumor control probabilities for stages T1, T2, and combined T1 and T2 as a function of the biological effective dose were fitted to the linear quadratic, universal survival curve, and regrowth models. Results: Forty-six studies met inclusion criteria. As measured by the goodness of fit χ 2 /ndf, with ndf as the number of degrees of freedom, none of the models were ideal fits for the data. Of the 3 models, the regrowth model provides the best fit to the clinical data. For the regrowth model, the fitting yielded an α-to-β ratio of approximately 25 Gy for T1 tumors, 19 Gy for T2 tumors, and 21 Gy for T1 and T2 combined. To achieve the maximal LC rate, the predicted physical dose schemes when prescribed at the periphery of the planning target volume are 43 ± 1 Gy in 3 fractions, 47 ± 1 Gy in 4 fractions, and 50 ± 1 Gy in 5 fractions for combined T1 and T2 tumors. Conclusions: Early-stage NSCLC is radioresponsive when treated with SBRT or stereotactic ablative radiation therapy. A steep dose-response relationship exists with high rates of durable LC when physical doses of 43-50 Gy are delivered in 3 to 5 fractions.",
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AU - Lee, Percy

AU - Loo, Billy W.

AU - Biswas, Tithi

AU - Ding, George X.

AU - El Naqa, Issam M.

AU - Jackson, Andrew

AU - Kong, Feng Ming

AU - LaCouture, Tamara

AU - Miften, Moyed

AU - Solberg, Timothy

AU - Tome, Wolfgang A.

AU - Tai, An

AU - Yorke, Ellen

AU - Li, X. Allen

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N2 - Purpose: Numerous dose and fractionation schedules have been used to treat medically inoperable stage I non-small cell lung cancer (NSCLC)with stereotactic body radiation therapy (SBRT)or stereotactic ablative radiation therapy. We evaluated published experiences with SBRT to determine local control (LC)rates as a function of SBRT dose. Methods and Materials: One hundred sixty published articles reporting LC rates after SBRT for stage I NSCLC were identified. Quality of the series was assessed by evaluating the number of patients in the study, homogeneity of the dose regimen, length of follow-up time, and reporting of LC. Clinical data including 1, 2, 3, and 5-year tumor control probabilities for stages T1, T2, and combined T1 and T2 as a function of the biological effective dose were fitted to the linear quadratic, universal survival curve, and regrowth models. Results: Forty-six studies met inclusion criteria. As measured by the goodness of fit χ 2 /ndf, with ndf as the number of degrees of freedom, none of the models were ideal fits for the data. Of the 3 models, the regrowth model provides the best fit to the clinical data. For the regrowth model, the fitting yielded an α-to-β ratio of approximately 25 Gy for T1 tumors, 19 Gy for T2 tumors, and 21 Gy for T1 and T2 combined. To achieve the maximal LC rate, the predicted physical dose schemes when prescribed at the periphery of the planning target volume are 43 ± 1 Gy in 3 fractions, 47 ± 1 Gy in 4 fractions, and 50 ± 1 Gy in 5 fractions for combined T1 and T2 tumors. Conclusions: Early-stage NSCLC is radioresponsive when treated with SBRT or stereotactic ablative radiation therapy. A steep dose-response relationship exists with high rates of durable LC when physical doses of 43-50 Gy are delivered in 3 to 5 fractions.

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