Lung Stereotactic Ablative Radiotherapy (SABR) for Medically Inoperable Peripheral Stage I Non-small Lung Cancer (NSCLC) at the St. James’s Institute of Oncology (SJIO)


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Satiavani Ramasamy1, Himabindu Musunuru1, Vicky Sangha1, Michael Flatley1, Robert Turner1, Robert Stuart1, Katy Clarke1, Alan Needham2, John Lilley2, Michael Snee1, Kevin Franks1
1Department of Clinical Oncology, St James Institute of Oncology, Leeds, UK, 2Department of Medical Physics, St James Institute of Oncology, Leeds, UK

Background

To evaluate the outcome of Lung SABR in medically inoperable peripheral Stage I NSCLC at the St. James Institute of Oncology.

Method

More than 300 patients since May 2009 have received SABR at SJIO. Included in this analysis are patients who received lung SABR between May 2009 and July 2011. All patients were reviewed at site specific MDTs and deemed medically inoperable with peripheral stage 1 lesions. Patients were scanned with 4DCT and verified using Cone Beam CT during treatment delivery. Electronic medical notes were reviewed for demographics, toxicities and response to treatment.

Results

148 patients were analysed with an 11 months median follow-up (1-32). The mean age was 74 (48-90). 152 tumours were treated out of 148 patients (4 patients treated with sequential/concurrent SBRT). 80% of tumours were T1 (<3cm) and 20% T2 (3-5cm). 86% of patients were of performance status ≤2 and 32% had pre-SBRT MRC breathlessness score≥3. Treatment was well tolerated. Within the first 6 weeks, 6 patients experienced grade ≥3 shortness of breath (SOB) and 6 patients had grade ≥3 fatigue. >6 weeks post SBRT, 6 patients had grade ≥3 SOB and 6 patients grade ≥3 chest pain. One patient had G4 hypoxia that possibly contributed to her death. Local control was maintained in 98% of patients. Patterns of relapse were local (2%), nodal (3.3%), and distal (13.5%). Median overall survival was 21 months (15.5-26.5) and median disease free survival 25months (23.0-27.3).

Conclusion

Our results compare to other published series showing low rates of acute toxicity and very high rates of local control. SABR was possible in patients with poor lung function, significant co-morbidity and previous lung surgery. We were also able to treat patients who had previous radiotherapy or multiple lesions. Outcomes are encouraging and we await more mature follow up data.