Author of

• 15301

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  P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Treatment of Localized Disease - NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 15338

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    P3.02-037 - Robotic SBRT with Fiducial Tracking for Inoperable Peripheral Stage I NSCLC: Mature Survival and Toxicity Outcomes (ID 2960)

    09:30 - 09:30  |  Author(s): F. Benovac
    • Abstract

    Background:
    Surgery is not an option for many patients with stage I non-small-cell lung cancer (NSCLC). Here we report mature robotic stereotactic body radiation therapy (SBRT) with fiducial tracking outcomes for inoperable patients with peripheral clinical stage I NSCLC.
    
    Methods:
    Inoperable patients with biopsy-proven peripheral clinical stage I NSCLC were treated. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs) were contoured using lung windows. The margins were expanded by 5 mm circumferentially to establish the planning treatment volume (PTV). Doses delivered to the PTV ranged from 45 to 60 Gy in 3 or 5 fractions (BED Gy~10 ~>100 Gy).
    
    Results:
    Forty patients ranging in age from 62-94 years (median age 76 years) with a median percent predicted FEV1 of 61% (range, 21-107%) were treated over a 6-year period extending from August 2005 to August 2011 and followed for a minimum of 40 months or until death. The median maximum tumor diameter was 2.6 cm (range, 1.4-5.0 cm). A median dose of 50 Gy was delivered over a 3 to 13 day period (median, 7 days). At a median potential follow-up of 56 months, the 5-year Kaplan-Meier locoregional and distant control estimates were 95% and 82%. The 5-year cancer-specific and overall survival estimates were 75% and 40%. There was no change in percent predicted FEV1 one year following robotic SBRT; there was a small but statistically significant 8% decline in percent predicted DLCO at one year. Radiation induced rib fracture (RIRF) was identified on surveillance CT imaging in 17 patients. The estimated cumulative incidence of RIRF at 3 years was 40%. The median time to rib fracture was 24 months (range, 7-38 months).
    
    Conclusion:
    Robotic SBRT with fiducial tracking outcomes for inoperable peripheral stage I NSCLC are comparable to conventional SBRT outcomes. Additional research will be required to determine the optimal SBRT technique.