Influence of Fractionation Scheme and Tumor Location on Toxicities After Stereotactic Body Radiation Therapy for Large (≥5 cm) Non-Small Cell Lung Cancer: A Multi-institutional Analysis
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States)
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (United States)
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States)
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon (United States)
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)
- Department of Radiation Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois (United States)
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida (United States)
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey (United States)
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (United States)
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California (United States)
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina (United States)
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky (United States)
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.
- OSTI ID:
- 22649867
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 97, Issue 4; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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