Stereotactic body radiation therapy for stage I non-small cell lung cancer: A small academic hospital experience

Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) has been shown to have increased local control and overall survival relative to conventional external beam radiation therapy in patients with medically inoperable stage I non-small cell lung cancer (NSCLC). Excellent rates of local control have been demonstrated both in clinical trials as well as in single center studies at large academic institutions. However, there is limited data on the experiences of small academic hospitals with SBRT for Stage I NSCLC. The purpose of this study is to report the local control and overall survival rates in patients treated with SBRT for Stage I NSCLC at Winthrop-University Hospital (WUH), a small academic hospital. Materials/Methods: This is a retrospective review of 78 Stage I central and peripheral NSCLC tumors treated between December 2006 and July 2012 with SBRT at WUH. Treatment was given utilizing fiducials and a respiratory tracking system. If the fiducials were not trackable, a spine tracking system was used for tumor localization. CT-based planning was performed using the ray trace algorithm. Treatment was delivered over consecutive days to a median dose of 4800 cGy delivered in 4 fractions. The Kaplan-Meier method was used to calculate local control and overall survival. Results: The median age was 78.5 years. 54% of the patient population was female. 67% of the tumors were Stage IA, and 33% of the tumors were Stage IB. 53% of the tumors were adenocarcinomas and 29% were squamous cell carcinomas, with the remainder being of unknown histology or NSCLC, not otherwise specified The 2-year local control rate was 87%, and the two-year overall survival was 68%. Conclusions: Our findings support that local control and overall survival at a small academic hospital are comparable to that of larger academic institutions' published experiences with SBRT for Stage I NSCLC.