ARJUN PENNATHUR, Steve A. Burton, James D. Luketich, Ghulam Abbas, Mang Chen, Dwight E. Heron, William E. Gooding, Cihat Ozhasoglu, Rodney J. Landreneau, Neil A. Christie; University of Pittsburgh Medical Center, PITTSBURGH, PA
Objective: Surgical resection is the standard of care for patients with non-small cell lung cancer (NSCLC). However, for high-risk patients, stereotactic radio surgery (SRS), offers an alternative therapeutic option. Our objective is to report our initial experience with SRS in the treatment of Stage I NSCLC by a combined team of thoracic surgeons and radiation oncologists.Methods: Patients who were medically inoperable were offered SRS. Thoracic surgeons evaluated all patients, placed the fiducials and performed treatment planning in collaboration with radiation oncologists. A median dose of 20 Gy to the 80% isodose line was administered in a single fraction. Initial response rate was assessed by CT scan and PET scan at 3 months. Time to progression (TTP) and Survival were monitored every 3 months.
Results: A total of 21 patients underwent SRS over a three-year period. There were 9 men and 12 women with a median age of 71 years (range 61-85). Percutaneous CT-guided fiducial placement resulted in pneumothorax requiring a pigtail catheter in 10 (10/21; 47%) patients. An initial complete response (CR) was observed in 7 patients (7/21; 33%), partial response (PR) in 5 (5/21; 24%), stable disease in 5 (5/21; 24%), and not evaluable in 1(1/21; 5%). Early progression occurred in 3 patients (3/21; 14%). During follow-up, local progression occurred in 9 nodules (9/21; 43%) and the median TTP was 12 months (CI 8.2-Not reached (NR). The remaining patients are locally progression-free at a median follow-up of 8.5months (CI 2-18). There were no procedure-related mortalities, 6 deaths occurred during follow-up. The median follow-up in the remaining patients was 11 months (5-31 months). The estimated probability of survival at 1 year was 90% (CI.64-.97), and the median survival was 26.4 months (CI 13.6-NR).
Conclusion: Our preliminary experience indicates SRS is safe in high-risk Stage I NSCLC patients with reasonable results. Surgery offers a better chance of cure for operable patients. However, Stereotactic Radiosurgery offers an alternative option in high-risk patients.
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