Risk-Adapted 4-Dimensional Stereotactic Radiotherapy an Option for Stage I Lung Cancer: Presented at ELCC

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Title: Risk-Adapted 4-Dimensional Stereotactic Radiotherapy an Option for Stage I Lung Cancer: Presented at ELCC
URL: http://www.pslgroup.com/dg/22021E.htm
Doctor's Guide
April 25, 2008

By Timothy A. O'Leary

GENEVA -- April 25, 2008 -- Stereotactic radiotherapy (SRT) is an "effective alternative" to surgery in patients with stage I non-small-cell lung cancer (NSCLC) who are either unfit for surgery or refuse surgery altogether, according to a study presented here at the 1st European Lung Cancer Conference (ELCC).

Frank J. Lagerwaard, MD, Radiation Oncologist, VU University Medical Centre, Amsterdam, Netherlands, and his collaborators have used SRT with a 4-dimensional target definition since April 2003. The frequency and intensity of the radiation dosage depends on the tumour size and location in relation to the thoracic wall, mediastinum, pericardium, or hilus.

Of their first 341 patients, 286 (84%) received SRT because they were medically inoperable, and 55 (16%) because they refused surgery.

Median overall survival rate at 1 year was 86%, 66% at 2 years, and 50% at 5 years.

Follow-up radio imaging showed local, regional, and distance failure in some of the patients. Local failure is loosely defined as the cancer remaining at or returning to the original site, regional failure as the cancer moving to a nearby site, and distance failure as the cancer migrating to a distant part of the body.

Local failure rate was 3% at 1 year, 8% at 2 years, and 11% at 3 years. Regional failure rate was 6% at 1 year, 16% at 2 years, and 16% at 3 years. Distance failure rate was 12% at 1 year, 25% at 2 years, and 34% at 3 years.

"Local control rates of 90% are achieved using SRT, making it an effective alternative to surgery in patients who are marginally fit for operation or refuse surgery," Dr. Lagerwaard said.

However, he added, "distance recurrence is a major problem."

Early toxicity was widespread but by no means universal. Fifty-one percent experienced no toxicity, 31% experienced fatigue, 12% had chest pain, 9% had nausea, 6% had dyspnoea, 6% had cough, 2% had erythema, 1% had haemoptysis, and 1% had palpitations.

Late toxicity was seen in a handful of patients: grade 3 radiation pneumonitis in 9 patients (3%); rib fractures, chronic chest wall pain, and pleural effusion each occurred in 3 (1%) patients.

"The incidence of severe early or late toxicity is low," Dr. Lagerwaard said.

Among the reasons to evaluate alternatives to surgery in patients with early-stage NSCLC, Dr. Lagerwaard included morbidity and mortality associated with surgery, especially in the elderly; the fact that resections more extensive than lobectomy are performed in 10% to 20% of patients; and the decrease in pulmonary function that often accompanies surgery.

[Presentation title: Risk-adapted 4D Stereotactic Radiotherapy for Stage I NSCLC: Early Experience With the First 300 Patients at the VU University Medical Center. Abstract 30IN]

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