Matthew Koshy1, Renuka Malik2, Ralph R Weichselbaum3, David J Sher4. 1. Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois. Electronic address: mkoshy@radonc.uchicago.edu. 2. Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois. 3. Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois. 4. Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
Abstract
PURPOSE: To determine the comparative effectiveness of different stereotactic body radiation therapy (SBRT) dosing regimens for early-stage non-small-cell lung cancer, using a large national database, focusing on the relative impact of dose as a function of tumor stage. METHODS AND MATERIALS: The study included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n=498). The biologically effective dose (BED) was calculated according to the linear quadratic formula using an α/β ratio of 10. High versus lower-dose (HD vs LD) SBRT was defined as a calculated BED above or below 150 Gy. Overall survival was estimated using Kaplan-Meier methods and Cox proportional hazard regression. RESULTS: The 5 most common dose fractionation schemes (percentage of cohort) used were 20 Gy × 3 (34%), 12 Gy × 4 (16%), 18 Gy × 3 (10%), 15 Gy × 3 (10%), and 16 Gy × 3 (4%). The median calculated BED was 150 Gy (interquartile range 106-166 Gy). The 3-year overall survival (OS) for patients who received HD versus LD was 55% versus 46% (log-rank P=.03). On subset analysis of the T1 cohort there was no association between calculated BED and 3-year OS (61% vs 60% with HD vs LD, P=.9). Among the T2 cohort, patients receiving HD experienced superior 3-year OS (37% vs 24%, P=.01). On multivariable analysis, factors independently prognostic for mortality were female gender (hazard ratio [HR] 0.76, P=.01), T2 tumor (HR 1.99, P=.0001), and HD (HR 0.68, P=.001). CONCLUSIONS: This comparative effectiveness analysis of SBRT dose for patients with stage I non-small-cell lung cancer suggests that higher doses (>150 Gy BED) are associated with a significant survival benefit in patients with T2 tumors.
PURPOSE: To determine the comparative effectiveness of different stereotactic body radiation therapy (SBRT) dosing regimens for early-stage non-small-cell lung cancer, using a large national database, focusing on the relative impact of dose as a function of tumor stage. METHODS AND MATERIALS: The study included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n=498). The biologically effective dose (BED) was calculated according to the linear quadratic formula using an α/β ratio of 10. High versus lower-dose (HD vs LD) SBRT was defined as a calculated BED above or below 150 Gy. Overall survival was estimated using Kaplan-Meier methods and Cox proportional hazard regression. RESULTS: The 5 most common dose fractionation schemes (percentage of cohort) used were 20 Gy × 3 (34%), 12 Gy × 4 (16%), 18 Gy × 3 (10%), 15 Gy × 3 (10%), and 16 Gy × 3 (4%). The median calculated BED was 150 Gy (interquartile range 106-166 Gy). The 3-year overall survival (OS) for patients who received HD versus LD was 55% versus 46% (log-rank P=.03). On subset analysis of the T1 cohort there was no association between calculated BED and 3-year OS (61% vs 60% with HD vs LD, P=.9). Among the T2 cohort, patients receiving HD experienced superior 3-year OS (37% vs 24%, P=.01). On multivariable analysis, factors independently prognostic for mortality were female gender (hazard ratio [HR] 0.76, P=.01), T2 tumor (HR 1.99, P=.0001), and HD (HR 0.68, P=.001). CONCLUSIONS: This comparative effectiveness analysis of SBRT dose for patients with stage I non-small-cell lung cancer suggests that higher doses (>150 Gy BED) are associated with a significant survival benefit in patients with T2 tumors.
Authors: Nicholas G Zaorsky; Charles T Lee; Eddie Zhang; Scott W Keith; Thomas J Galloway Journal: Radiother Oncol Date: 2017-08-23 Impact factor: 6.280
Authors: Neil M Woody; Kevin L Stephans; Martin Andrews; Tingliang Zhuang; Priyanka Gopal; Ping Xia; Carol F Farver; Daniel P Raymond; Craig D Peacock; Joseph Cicenia; Chandana A Reddy; Gregory M M Videtic; Mohamed E Abazeed Journal: J Thorac Oncol Date: 2016-12-22 Impact factor: 15.609
Authors: Jingjing Kang; Matthew S Ning; Han Feng; Hongqi Li; Houda Bahig; Eric D Brooks; James W Welsh; Rui Ye; Hongyu Miao; Joe Y Chang Journal: Int J Radiat Oncol Biol Phys Date: 2019-10-03 Impact factor: 7.038