Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis

Daniel H. Schanne; Ursula Nestle; Michael Allgäuer; Nicolaus Andratschke; Steffen Appold; Ute Dieckmann; Iris Ernst; Ute Ganswindt; Anca L. Grosu; Richard Holy; Michael Molls; Meinhard Nevinny-Stickel; Sabine Semrau; Florian Sterzing; Andrea Wittig; Matthias Guckenberger

doi:10.1007/s00066-014-0739-5

Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis

Translated title of the contribution: Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis

Daniel H. Schanne
, Ursula Nestle
, Michael Allgäuer
, Nicolaus Andratschke
, Steffen Appold
, Ute Dieckmann
, Iris Ernst
, Ute Ganswindt
, Anca L. Grosu
, Richard Holy
, Michael Molls
, Meinhard Nevinny-Stickel
, Sabine Semrau
, Florian Sterzing
, Andrea Wittig
, Matthias Guckenberger

TUM Institute for Advanced Study

University of Freiburg
Barmherzige Brüder
Technical University of Munich
Universitätsklinikum Carl Gustav Carus Dresden
Medical University of Vienna
Universitätsklinikum Münster
University of Munich
University Hospital
Medical University Innsbruck
Universitätsklinikum Erlangen
University Hospital Heidelberg
Philipps-Universität Marburg
University of Würzburg

Research output: Contribution to journal › Article › peer-review

55 Scopus citations

Abstract

Purpose: The purpose of this work is to analyze patterns of care and outcome after stereotactic body radiotherapy (SBRT) for centrally located, early-stage, non-small cell lung cancer (NSCLC) and to address the question of potential risk for increased toxicity in this entity.

Methods and materials: A total of 90 patients with centrally located NSCLC were identified among 613 cases in a database of 13 German and Austrian academic radiotherapy centers. The outcome of centrally located NSCLC was compared to that of cases with peripheral tumor location from the same database.

Results: Patients with central tumors most commonly presented with UICC stage IB (50 %), while the majority of peripheral lesions were stage IA (56 %). Average tumor diameters were 3.3 cm (central) and 2.8 cm (peripheral). Staging PET/CT was available for 73 and 74 % of peripheral and central tumors, respectively. Biopsy was performed in 84 % (peripheral) and 88 % (central) of cases. Doses varied significantly between central and peripheral lesions with a median BED₁₀of 72 Gy and 84 Gy, respectively (p < 0.001). Fractionation differed as well with medians of 5 (central) and 3 (peripheral) fractions (p < 0.001). In the Kaplan–Meier analysis, 3-year actuarial overall survival was 29 % (central) and 51 % (peripheral; p = 0.004) and freedom from local progression was 52 % (central) and 84 % (peripheral; p < 0.001). Toxicity after treatment of central tumors was low with no grade III/IV and one grade V event. Mortality rates were 0 and 1 % after 30 and 60 days, respectively.

Conclusion: Local tumor control in patients treated with SBRT for centrally located, early-stage NSCLC was favorable, provided ablative radiation doses were prescribed. This was, however, not the case in the majority of patients, possibly due to concerns about treatment-related toxicity. Reported toxicity was low, but prospective trials are needed to resolve the existing uncertainties and to establish safe high-dose regimens for this cohort of patients.

Translated title of the contribution	Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis
Original language	English
Pages (from-to)	125-132
Number of pages	8
Journal	Strahlentherapie und Onkologie
Volume	191
Issue number	2
DOIs	https://doi.org/10.1007/s00066-014-0739-5
State	Published - Feb 2014

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Central lung cancer
Fluorodeoxyglucose F18
Non-small cell lung cancer
Positron-emission tomography PET
Toxicity

Access to Document

10.1007/s00066-014-0739-5

Cite this

Schanne, D. H., Nestle, U., Allgäuer, M., Andratschke, N., Appold, S., Dieckmann, U., Ernst, I., Ganswindt, U., Grosu, A. L., Holy, R., Molls, M., Nevinny-Stickel, M., Semrau, S., Sterzing, F., Wittig, A., & Guckenberger, M. (2014). Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis. Strahlentherapie und Onkologie, 191(2), 125-132. https://doi.org/10.1007/s00066-014-0739-5

@article{243d9befc80d46e5b8d74b780501bf82,

title = "Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis",

abstract = "Purpose: The purpose of this work is to analyze patterns of care and outcome after stereotactic body radiotherapy (SBRT) for centrally located, early-stage, non-small cell lung cancer (NSCLC) and to address the question of potential risk for increased toxicity in this entity.Methods and materials: A total of 90 patients with centrally located NSCLC were identified among 613 cases in a database of 13 German and Austrian academic radiotherapy centers. The outcome of centrally located NSCLC was compared to that of cases with peripheral tumor location from the same database.Results: Patients with central tumors most commonly presented with UICC stage IB (50 \%), while the majority of peripheral lesions were stage IA (56 \%). Average tumor diameters were 3.3 cm (central) and 2.8 cm (peripheral). Staging PET/CT was available for 73 and 74 \% of peripheral and central tumors, respectively. Biopsy was performed in 84 \% (peripheral) and 88 \% (central) of cases. Doses varied significantly between central and peripheral lesions with a median BED10of 72 Gy and 84 Gy, respectively (p < 0.001). Fractionation differed as well with medians of 5 (central) and 3 (peripheral) fractions (p < 0.001). In the Kaplan–Meier analysis, 3-year actuarial overall survival was 29 \% (central) and 51 \% (peripheral; p = 0.004) and freedom from local progression was 52 \% (central) and 84 \% (peripheral; p < 0.001). Toxicity after treatment of central tumors was low with no grade III/IV and one grade V event. Mortality rates were 0 and 1 \% after 30 and 60 days, respectively.Conclusion: Local tumor control in patients treated with SBRT for centrally located, early-stage NSCLC was favorable, provided ablative radiation doses were prescribed. This was, however, not the case in the majority of patients, possibly due to concerns about treatment-related toxicity. Reported toxicity was low, but prospective trials are needed to resolve the existing uncertainties and to establish safe high-dose regimens for this cohort of patients.",

keywords = "Central lung cancer, Fluorodeoxyglucose F18, Non-small cell lung cancer, Positron-emission tomography PET, Toxicity",

author = "Schanne, \{Daniel H.\} and Ursula Nestle and Michael Allg{\"a}uer and Nicolaus Andratschke and Steffen Appold and Ute Dieckmann and Iris Ernst and Ute Ganswindt and Grosu, \{Anca L.\} and Richard Holy and Michael Molls and Meinhard Nevinny-Stickel and Sabine Semrau and Florian Sterzing and Andrea Wittig and Matthias Guckenberger",

note = "Publisher Copyright: {\textcopyright} 2014, Springer-Verlag Berlin Heidelberg.",

year = "2014",

month = feb,

doi = "10.1007/s00066-014-0739-5",

language = "English",

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pages = "125--132",

journal = "Strahlentherapie und Onkologie",

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Schanne, DH, Nestle, U, Allgäuer, M, Andratschke, N, Appold, S, Dieckmann, U, Ernst, I, Ganswindt, U, Grosu, AL, Holy, R, Molls, M, Nevinny-Stickel, M, Semrau, S, Sterzing, F, Wittig, A & Guckenberger, M 2014, 'Stereotactic body radiotherapy for centrally located stage I NSCLC: A multicenter analysis', Strahlentherapie und Onkologie, vol. 191, no. 2, pp. 125-132. https://doi.org/10.1007/s00066-014-0739-5

TY - JOUR

T1 - Stereotactic body radiotherapy for centrally located stage I NSCLC

T2 - A multicenter analysis

AU - Schanne, Daniel H.

AU - Nestle, Ursula

AU - Allgäuer, Michael

AU - Andratschke, Nicolaus

AU - Appold, Steffen

AU - Dieckmann, Ute

AU - Ernst, Iris

AU - Ganswindt, Ute

AU - Grosu, Anca L.

AU - Holy, Richard

AU - Molls, Michael

AU - Nevinny-Stickel, Meinhard

AU - Semrau, Sabine

AU - Sterzing, Florian

AU - Wittig, Andrea

AU - Guckenberger, Matthias

PY - 2014/2

Y1 - 2014/2

N2 - Purpose: The purpose of this work is to analyze patterns of care and outcome after stereotactic body radiotherapy (SBRT) for centrally located, early-stage, non-small cell lung cancer (NSCLC) and to address the question of potential risk for increased toxicity in this entity.Methods and materials: A total of 90 patients with centrally located NSCLC were identified among 613 cases in a database of 13 German and Austrian academic radiotherapy centers. The outcome of centrally located NSCLC was compared to that of cases with peripheral tumor location from the same database.Results: Patients with central tumors most commonly presented with UICC stage IB (50 %), while the majority of peripheral lesions were stage IA (56 %). Average tumor diameters were 3.3 cm (central) and 2.8 cm (peripheral). Staging PET/CT was available for 73 and 74 % of peripheral and central tumors, respectively. Biopsy was performed in 84 % (peripheral) and 88 % (central) of cases. Doses varied significantly between central and peripheral lesions with a median BED10of 72 Gy and 84 Gy, respectively (p < 0.001). Fractionation differed as well with medians of 5 (central) and 3 (peripheral) fractions (p < 0.001). In the Kaplan–Meier analysis, 3-year actuarial overall survival was 29 % (central) and 51 % (peripheral; p = 0.004) and freedom from local progression was 52 % (central) and 84 % (peripheral; p < 0.001). Toxicity after treatment of central tumors was low with no grade III/IV and one grade V event. Mortality rates were 0 and 1 % after 30 and 60 days, respectively.Conclusion: Local tumor control in patients treated with SBRT for centrally located, early-stage NSCLC was favorable, provided ablative radiation doses were prescribed. This was, however, not the case in the majority of patients, possibly due to concerns about treatment-related toxicity. Reported toxicity was low, but prospective trials are needed to resolve the existing uncertainties and to establish safe high-dose regimens for this cohort of patients.

AB - Purpose: The purpose of this work is to analyze patterns of care and outcome after stereotactic body radiotherapy (SBRT) for centrally located, early-stage, non-small cell lung cancer (NSCLC) and to address the question of potential risk for increased toxicity in this entity.Methods and materials: A total of 90 patients with centrally located NSCLC were identified among 613 cases in a database of 13 German and Austrian academic radiotherapy centers. The outcome of centrally located NSCLC was compared to that of cases with peripheral tumor location from the same database.Results: Patients with central tumors most commonly presented with UICC stage IB (50 %), while the majority of peripheral lesions were stage IA (56 %). Average tumor diameters were 3.3 cm (central) and 2.8 cm (peripheral). Staging PET/CT was available for 73 and 74 % of peripheral and central tumors, respectively. Biopsy was performed in 84 % (peripheral) and 88 % (central) of cases. Doses varied significantly between central and peripheral lesions with a median BED10of 72 Gy and 84 Gy, respectively (p < 0.001). Fractionation differed as well with medians of 5 (central) and 3 (peripheral) fractions (p < 0.001). In the Kaplan–Meier analysis, 3-year actuarial overall survival was 29 % (central) and 51 % (peripheral; p = 0.004) and freedom from local progression was 52 % (central) and 84 % (peripheral; p < 0.001). Toxicity after treatment of central tumors was low with no grade III/IV and one grade V event. Mortality rates were 0 and 1 % after 30 and 60 days, respectively.Conclusion: Local tumor control in patients treated with SBRT for centrally located, early-stage NSCLC was favorable, provided ablative radiation doses were prescribed. This was, however, not the case in the majority of patients, possibly due to concerns about treatment-related toxicity. Reported toxicity was low, but prospective trials are needed to resolve the existing uncertainties and to establish safe high-dose regimens for this cohort of patients.

KW - Central lung cancer

KW - Fluorodeoxyglucose F18

KW - Non-small cell lung cancer

KW - Positron-emission tomography PET

KW - Toxicity

UR - https://www.scopus.com/pages/publications/84922322598

U2 - 10.1007/s00066-014-0739-5

DO - 10.1007/s00066-014-0739-5

M3 - Article

C2 - 25159135

AN - SCOPUS:84922322598

SN - 0179-7158

VL - 191

SP - 125

EP - 132

JO - Strahlentherapie und Onkologie

JF - Strahlentherapie und Onkologie

IS - 2

ER -