Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: Clinical implications

Alexander Chi, Zhongxing Liao, Nam P. Nguyen, Jiahong Xu, Baldassarre Stea, Ritsuko Komaki

Research output: Contribution to journalReview articlepeer-review

261 Scopus citations

Abstract

Purpose: To analyze the patterns of failure, the toxicity profile, and the factors influencing efficacy of stereotactic body radiation (SBRT) for early-stage non-small-cell lung cancer (NSCLC). Methods and materials: A search was based on PubMed electronic databases. All searches were conducted in May, 2009. Results: The local control ranged from 80% to 100% in most studies with adequate isocentric or peripheral biologically effective dose (BED). Recurrences were associated with increased tumor size. The main pattern of failure after SBRT was distant metastasis. Grades 3-5 toxicity occurred mostly in centrally located tumors, and adjuvant chemotherapy may further decrease all recurrences; possibly translating to a survival benefit in large or centrally located tumors where high BED cannot be safely reached. Conclusion: SBRT is an excellent treatment option for early-stage, and mostly medically inoperable, NSCLC. BED at both the isocenter and the tumor periphery is very important for optimal tumor control; higher doses are required for large (≥T2) lesions; SBRT for centrally located tumors can be feasible with a much less aggressive dose regimen than 60-66 Gy/3 fractions and adjacent critical structures excluded from the target volume; chemotherapy may optimize the clinical outcome in large or centrally located lesions.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalRadiotherapy and Oncology
Volume94
Issue number1
DOIs
StatePublished - Jan 1 2010

Keywords

  • BED
  • Non-small-cell lung cancer
  • Pneumonitis
  • Radiotherapy
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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