TY - JOUR
T1 - Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer
T2 - Clinical implications
AU - Chi, Alexander
AU - Liao, Zhongxing
AU - Nguyen, Nam P.
AU - Xu, Jiahong
AU - Stea, Baldassarre
AU - Komaki, Ritsuko
PY - 2010/1
Y1 - 2010/1
N2 - 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.
AB - 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.
KW - BED
KW - Non-small-cell lung cancer
KW - Pneumonitis
KW - Radiotherapy
KW - Stereotactic body radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=74549188119&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=74549188119&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2009.12.008
DO - 10.1016/j.radonc.2009.12.008
M3 - Review article
C2 - 20074823
AN - SCOPUS:74549188119
SN - 0167-8140
VL - 94
SP - 1
EP - 11
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 1
ER -