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Stereotactic body radiotherapy for medically inoperable patients with stage I non-small cell lung cancer - A first report of toxicity related to COPD/CVD in a non-randomized prospective phase II study
Divisions of Oncology, Hospital Physics, Radiumhemment, Sweden.
Department of Oncology and Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Divisions of Oncology and Medical Physics, Aarhus University Hospital, Denmark.
Divisions of Oncology, Hospital Physics, Radiumhemment, Sweden.
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2008 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, Vol. 88, no 3, 359-367 p.Article in journal (Refereed) Published
Abstract [en]

Background and Aims: In a retrospective study using stereotactic body radiotherapy (SBRT) in medically inoperable patients with stage I NSCLC we previously reported a local control rate of 88% utilizing a median dose of 15 Gy × 3. This report records the toxicity encountered in a prospective phase II trial, and its relation to coexisting chronic obstructive pulmonary disease (COPD) and cardio vascular disease (CVD). Material and methods: Sixty patients were entered in the study between August 2003 and September 2005. Fifty-seven patients (T1 65%, T2 35%) with a median age of 75 years (59-87 years) were evaluable. The baseline mean FEV1% was 64% and median Karnofsky index was 80. A total dose of 45 Gy was delivered in three fractions at the 67% isodose of the PTV. Clinical, pulmonary and radiological evaluations were made at 6 weeks, 3, 6, 9, 12, 18, and 36 months post-SBRT. Toxicity was graded according to CTC v2.0 and performance status was graded according to the Karnofsky scale. Results: At a median follow-up of 23 months, 2 patients had relapsed locally. No grade 4 or 5 toxicity was reported. Grade 3 toxicity was seen in 12 patients (21%). There was no significant decline of FEV1% during follow-up. Low grade pneumonitis developed to the same extent in the CVD 3/17 (18%) and COPD 7/40 (18%) groups. The incidence of fibrosis was 9/17 (53%) and pleural effusions was 8/17 (47%) in the CVD group compared with 13/40 (33%) and 5/40 (13%) in the COPD group. Conclusion: SBRT for stage I NSCLC patients who are medically inoperable because of COPD and CVD results in a favourable local control rate with a low incidence of grade 3 and no grade 4 or 5 toxicity. © 2008 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
2008. Vol. 88, no 3, 359-367 p.
Keyword [en]
COPD, CVD, Inoperable stage I NSCLC, SBRT
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-50265DOI: 10.1016/j.radonc.2008.07.019OAI: diva2:271161
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2011-01-11

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Sederholm, Christer
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Faculty of Health SciencesPulmonary Medicine Department of Respiratory Medicine UHL
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