Vivek Verma1, Valerie K Shostrom2, Weining Zhen1, Mutian Zhang1, Steve E Braunstein3, John Holland4, Christopher L Hallemeier5, Matthew M Harkenrider6, Adrian Iskhanian7, Salma K Jabbour8, Albert Attia9, Percy Lee10, Kyle Wang11, Roy H Decker12, Ronald C McGarry13, Charles B Simone14. 1. Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska. 2. Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. 3. Department of Radiation Oncology, University of California, San Francisco, San Francisco, California. 4. Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon. 5. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 6. Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois. 7. Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida. 8. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey. 9. Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee. 10. Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California. 11. Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 12. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut. 13. Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky. 14. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. Electronic address: charlessimone@umm.edu.
Abstract
PURPOSE: To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. METHODS: Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. RESULTS: Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05). CONCLUSIONS: From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.
PURPOSE: To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis. METHODS:Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed. RESULTS: Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05). CONCLUSIONS: From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.
Authors: Alexander N Hanania; Walker Mainwaring; Yohannes T Ghebre; Nicola A Hanania; Michelle Ludwig Journal: Chest Date: 2019-04-15 Impact factor: 9.410
Authors: Melissa A L Vyfhuis; Nasarachi Onyeuku; Tejan Diwanji; Sina Mossahebi; Neha P Amin; Shahed N Badiyan; Pranshu Mohindra; Charles B Simone Journal: Ther Adv Respir Dis Date: 2018 Jan-Dec Impact factor: 4.031