Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer

Vivek Verma, Charles B. Simone, Pamela K. Allen, Sameer R. Gajjar, Chirag Shah, Weining Zhen, Matthew M. Harkenrider, Christopher L. Hallemeier, Salma Jabbour, Chance L. Matthiesen, Steve E. Braunstein, Percy Lee, Thomas J. Dilling, Bryan G. Allen, Elizabeth M. Nichols, Albert Attia, Jing Zeng, Tithi Biswas, Peter Paximadis, Fen WangJoshua M. Walker, John M. Stahl, Megan E. Daly, Roy H. Decker, Russell K. Hales, Henning Willers, Gregory M.M. Videtic, Minesh P. Mehta, Steven H. Lin

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Abstract

Purpose For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. Methods and Materials The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. Results From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and “elsewhere lung” (20.8%). The median time to each was 5 to 7 months. Conclusions From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.

Original languageEnglish (US)
Pages (from-to)362-371
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume97
Issue number2
DOIs
StatePublished - Feb 1 2017

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Small Cell Lung Carcinoma
lungs
radiation therapy
Radiotherapy
cancer
Disease-Free Survival
Drug Therapy
Survival
chemotherapy
Multivariate Analysis
Dose Fractionation
Cranial Irradiation
Kaplan-Meier Estimate
toxicity
Treatment Failure
Pneumonia
Cohort Studies
Survival Rate
Guidelines
Recurrence

All Science Journal Classification (ASJC) codes

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

Cite this

Verma, Vivek ; Simone, Charles B. ; Allen, Pamela K. ; Gajjar, Sameer R. ; Shah, Chirag ; Zhen, Weining ; Harkenrider, Matthew M. ; Hallemeier, Christopher L. ; Jabbour, Salma ; Matthiesen, Chance L. ; Braunstein, Steve E. ; Lee, Percy ; Dilling, Thomas J. ; Allen, Bryan G. ; Nichols, Elizabeth M. ; Attia, Albert ; Zeng, Jing ; Biswas, Tithi ; Paximadis, Peter ; Wang, Fen ; Walker, Joshua M. ; Stahl, John M. ; Daly, Megan E. ; Decker, Roy H. ; Hales, Russell K. ; Willers, Henning ; Videtic, Gregory M.M. ; Mehta, Minesh P. ; Lin, Steven H. / Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 97, No. 2. pp. 362-371.
@article{1f1cc175efb44e5da7b47e02b191c357,
title = "Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer",
abstract = "Purpose For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. Methods and Materials The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. Results From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56{\%} and 23{\%} of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4{\%} and 96.1{\%}, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3{\%} and 53.2{\%} at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5{\%}, and 64.4{\%}, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9{\%}, and 34.0{\%} respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2{\%} experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8{\%} of recurrence), followed by nodal (25.0{\%}) and “elsewhere lung” (20.8{\%}). The median time to each was 5 to 7 months. Conclusions From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.",
author = "Vivek Verma and Simone, {Charles B.} and Allen, {Pamela K.} and Gajjar, {Sameer R.} and Chirag Shah and Weining Zhen and Harkenrider, {Matthew M.} and Hallemeier, {Christopher L.} and Salma Jabbour and Matthiesen, {Chance L.} and Braunstein, {Steve E.} and Percy Lee and Dilling, {Thomas J.} and Allen, {Bryan G.} and Nichols, {Elizabeth M.} and Albert Attia and Jing Zeng and Tithi Biswas and Peter Paximadis and Fen Wang and Walker, {Joshua M.} and Stahl, {John M.} and Daly, {Megan E.} and Decker, {Roy H.} and Hales, {Russell K.} and Henning Willers and Videtic, {Gregory M.M.} and Mehta, {Minesh P.} and Lin, {Steven H.}",
year = "2017",
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doi = "10.1016/j.ijrobp.2016.10.041",
language = "English (US)",
volume = "97",
pages = "362--371",
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Verma, V, Simone, CB, Allen, PK, Gajjar, SR, Shah, C, Zhen, W, Harkenrider, MM, Hallemeier, CL, Jabbour, S, Matthiesen, CL, Braunstein, SE, Lee, P, Dilling, TJ, Allen, BG, Nichols, EM, Attia, A, Zeng, J, Biswas, T, Paximadis, P, Wang, F, Walker, JM, Stahl, JM, Daly, ME, Decker, RH, Hales, RK, Willers, H, Videtic, GMM, Mehta, MP & Lin, SH 2017, 'Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer', International Journal of Radiation Oncology Biology Physics, vol. 97, no. 2, pp. 362-371. https://doi.org/10.1016/j.ijrobp.2016.10.041

Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer. / Verma, Vivek; Simone, Charles B.; Allen, Pamela K.; Gajjar, Sameer R.; Shah, Chirag; Zhen, Weining; Harkenrider, Matthew M.; Hallemeier, Christopher L.; Jabbour, Salma; Matthiesen, Chance L.; Braunstein, Steve E.; Lee, Percy; Dilling, Thomas J.; Allen, Bryan G.; Nichols, Elizabeth M.; Attia, Albert; Zeng, Jing; Biswas, Tithi; Paximadis, Peter; Wang, Fen; Walker, Joshua M.; Stahl, John M.; Daly, Megan E.; Decker, Roy H.; Hales, Russell K.; Willers, Henning; Videtic, Gregory M.M.; Mehta, Minesh P.; Lin, Steven H.

In: International Journal of Radiation Oncology Biology Physics, Vol. 97, No. 2, 01.02.2017, p. 362-371.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer

AU - Verma, Vivek

AU - Simone, Charles B.

AU - Allen, Pamela K.

AU - Gajjar, Sameer R.

AU - Shah, Chirag

AU - Zhen, Weining

AU - Harkenrider, Matthew M.

AU - Hallemeier, Christopher L.

AU - Jabbour, Salma

AU - Matthiesen, Chance L.

AU - Braunstein, Steve E.

AU - Lee, Percy

AU - Dilling, Thomas J.

AU - Allen, Bryan G.

AU - Nichols, Elizabeth M.

AU - Attia, Albert

AU - Zeng, Jing

AU - Biswas, Tithi

AU - Paximadis, Peter

AU - Wang, Fen

AU - Walker, Joshua M.

AU - Stahl, John M.

AU - Daly, Megan E.

AU - Decker, Roy H.

AU - Hales, Russell K.

AU - Willers, Henning

AU - Videtic, Gregory M.M.

AU - Mehta, Minesh P.

AU - Lin, Steven H.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Purpose For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. Methods and Materials The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. Results From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and “elsewhere lung” (20.8%). The median time to each was 5 to 7 months. Conclusions From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.

AB - Purpose For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. Methods and Materials The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. Results From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and “elsewhere lung” (20.8%). The median time to each was 5 to 7 months. Conclusions From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.

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