BACKGROUND: Surgical resection is the standard of care for patients with resectable non-small cell lung carcinoma (NSCLC) or limited pulmonary metastases. Stereotactic radiosurgery (SRS) may offer an alternative option for high-risk patients who are not surgical candidates. We report our initial experience with SRS in the treatment of lung neoplasm. METHODS: Patients who were medically inoperable were offered SRS. Thoracic surgeons evaluated all patients, placed fiducials, and planned treatment in collaboration with radiation oncologists. A median dose of 20 Gy prescribed to the 80% isodose line was administered in a single fraction. The initial response rate, time to progression, and overall survival were evaluated. RESULTS: During a 2-year period, 32 patients, 27 with NSCLC and 5 with pulmonary metastases, underwent SRS. Fiducial placement resulted in a pneumothorax requiring a pigtail catheter in 9 patients (28%). An initial complete response was observed in 7 patients (22%) and partial response in 10 (31%). Disease was stable in 9 (28%) and progression occurred in 5 patients (16%), with a median time to local progression of 11 months. The median overall survival was 26 months. The probability of 1-year overall survival was 78% (95% confidence interval [CI], 65% to 94%) for the entire group and 91% (95% CI, 75% to 100%) for stage I patients. CONCLUSIONS: Our preliminary experience indicates that SRS has reasonable results in this high-risk group of patients, with pneumothorax being a significant morbidity. Surgery continues to offer the best chance of cure for resectable patients; however, SRS offers an alternative to high-risk patients.
BACKGROUND: Surgical resection is the standard of care for patients with resectable non-small cell lung carcinoma (NSCLC) or limited pulmonary metastases. Stereotactic radiosurgery (SRS) may offer an alternative option for high-risk patients who are not surgical candidates. We report our initial experience with SRS in the treatment of lung neoplasm. METHODS:Patients who were medically inoperable were offered SRS. Thoracic surgeons evaluated all patients, placed fiducials, and planned treatment in collaboration with radiation oncologists. A median dose of 20 Gy prescribed to the 80% isodose line was administered in a single fraction. The initial response rate, time to progression, and overall survival were evaluated. RESULTS: During a 2-year period, 32 patients, 27 with NSCLC and 5 with pulmonary metastases, underwent SRS. Fiducial placement resulted in a pneumothorax requiring a pigtail catheter in 9 patients (28%). An initial complete response was observed in 7 patients (22%) and partial response in 10 (31%). Disease was stable in 9 (28%) and progression occurred in 5 patients (16%), with a median time to local progression of 11 months. The median overall survival was 26 months. The probability of 1-year overall survival was 78% (95% confidence interval [CI], 65% to 94%) for the entire group and 91% (95% CI, 75% to 100%) for stage I patients. CONCLUSIONS: Our preliminary experience indicates that SRS has reasonable results in this high-risk group of patients, with pneumothorax being a significant morbidity. Surgery continues to offer the best chance of cure for resectable patients; however, SRS offers an alternative to high-risk patients.
Authors: Sana D Karam; Zachary D Horne; Robert L Hong; Nimrah Baig; Gregory J Gagnon; Don McRae; David Duhamel; Nadim M Nasr Journal: Lung Cancer (Auckl) Date: 2013-08-06
Authors: Brian T Collins; Saloomeh Vahdat; Kelly Erickson; Sean P Collins; Simeng Suy; Xia Yu; Ying Zhang; Deepa Subramaniam; Cristina A Reichner; Ismet Sarikaya; Giuseppe Esposito; Shadi Yousefi; Carlos Jamis-Dow; Filip Banovac; Eric D Anderson Journal: J Hematol Oncol Date: 2009-01-17 Impact factor: 17.388