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Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma†
Clinical outcomes in 245 subjects in a Japanese multiinstitutional study
Article first published online: 18 AUG 2004
Copyright © 2004 American Cancer Society
Volume 101, Issue 7, pages 1623–1631, 1 October 2004
How to Cite
Onishi, H., Araki, T., Shirato, H., Nagata, Y., Hiraoka, M., Gomi, K., Yamashita, T., Niibe, Y., Karasawa, K., Hayakawa, K., Takai, Y., Kimura, T., Hirokawa, Y., Takeda, A., Ouchi, A., Hareyama, M., Kokubo, M., Hara, R., Itami, J. and Yamada, K. (2004), Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma. Cancer, 101: 1623–1631. doi: 10.1002/cncr.20539
Presented at the 45th Annual Meeting of the American Society of Therapeutic Radiation Oncology (ASTRO), Salt Lake City, Utah, October 20–23, 2003.
- Issue published online: 17 SEP 2004
- Article first published online: 18 AUG 2004
- Manuscript Accepted: 21 JUN 2004
- Manuscript Revised: 12 JUN 2004
- Manuscript Received: 2 MAR 2004
- altered fractionation;
- nonsmall cell lung carcinoma;
- Stage I;
- dose escalation;
- multicenter study;
- local control;
- survival rate
Stereotactic irradiation (STI) has been actively performed using various methods to achieve better local control of Stage I nonsmall cell lung carcinoma (NSCLC) in Japan. The authors retrospectively evaluated results from a Japanese multiinstitutional study.
Patients with Stage I NSCLC (n = 245; median age, 76 years; T1N0M0, n=155; T2N0M0, n=90) were treated with hypofractionated high-dose STI in 13 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. A total dose of 18–75 gray (Gy) at the isocenter was administered in 1–22 fractions. The median calculated biologic effective dose (BED) was 108 Gy (range, 57–180 Gy).
During follow-up (median, 24 months; range, 7–78 months), pulmonary complications of National Cancer Institute-Common Toxicity Criteria Grade > 2 were observed in only 6 patients (2.4%). Local progression occurred in 33 patients (14.5%), and the local recurrence rate was 8.1% for BED ≥ 100 Gy compared with 26.4% for < 100 Gy (P < 0.05). The 3-year overall survival rate of medically operable patients was 88.4% for BED ≥ 100 Gy compared with 69.4% for < 100 Gy (P < 0.05).
Hypofractionated high-dose STI with BED < 150 Gy was feasible and beneficial for curative treatment of patients with Stage I NSCLC. For all treatment methods and schedules, local control and survival rates were better with BED ≥ 100 Gy compared with < 100 Gy. Survival rates in selected patients (medically operable, BED ≥ 100 Gy) were excellent, and were potentially comparable to those of surgery. Cancer 2004. © 2004 American Cancer Society.