A pilot study of stereotactic body radiation therapy (SBRT) after surgery for stage III non-small cell lung cancer

Anurag K Singh, Mark Hennon, Sung Jun Ma, Todd L Demmy, Anthony Picone, Elizabeth U Dexter, Chumy Nwogu, Kristopher Attwood, Wei Tan, Gregory M Hermann, Simon Fung-Kee-Fung, Harish K Malhotra, Sai Yendamuri, Jorge A Gomez-Suescun, Anurag K Singh, Mark Hennon, Sung Jun Ma, Todd L Demmy, Anthony Picone, Elizabeth U Dexter, Chumy Nwogu, Kristopher Attwood, Wei Tan, Gregory M Hermann, Simon Fung-Kee-Fung, Harish K Malhotra, Sai Yendamuri, Jorge A Gomez-Suescun

Abstract

Background: Standard therapy for stage III non-small cell lung cancer with chemotherapy and conventional radiation has suboptimal outcomes. We hypothesized that a combination of surgery followed by stereotactic body radiation therapy (SBRT) would be a safe alternative.

Methods: Patients with stage IIIA (multistation N2) or IIIB non-small cell lung cancer were enrolled from March 2013 to December 2015. The protocol included transcervical extended mediastinal lymphadenectomy (TEMLA) followed by surgical resection, 10 Gy SBRT directed to the involved mediastinum/hilar stations and/or positive surgical margins, and adjuvant systemic therapy. Patients not suitable for anatomic lung resection were treated with 30 Gy to the primary tumor. The primary efficacy end-point was the proportion of patients with grade 3 or higher adverse events (AE) or toxicities.

Results: Of 10 patients, 7 patients underwent neoadjuvant chemotherapy. All patients had TEMLA. Nine of 10 patients underwent surgical resection. The remaining patient had an unresectable tumor and received 30 Gy SBRT to the primary lesion. All patients had post-operative SBRT. Median follow-up was 18 months. There were no perioperative mortalities. Six patients had any grade 3 AEs with no grade 4-5 AEs. Of these, 4 were not attributable to radiation. Pulmonary-related grade 3 AEs were experienced by 2 patients. There were no failures within the 10 Gy volume. Overall survival and progression-free survival rates at 2 years were 68% (90% CI 36-86) and 40% (90% CI 16-63), respectively.

Conclusions: In carefully selected patients with locally advanced non-small cell lung cancer, combining surgery with SBRT was well tolerated with no local failure.

Trial registration: ClinicalTrials.gov identifying number NCT01781741 . Registered February 1, 2013.

Keywords: Adjuvant; Mediastinum; Post-operative; RT; SABR.

Conflict of interest statement

Ethics approval and consent to participate

Institutional review board approval was obtained at the Roswell Park Comprehensive Cancer Center (I 223812). ClinicalTrials.gov identifying number NCT01781741. All patients provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Example of the nodal contour for patient No. 3 who had a clinically positive level 10 lymph node and a positive level 4 lymph node from TEMLA. a Axial view b. Coronal view. Clinical Target Volume (CTV) (blue) and Planning Target Volume (PTV) (purple)
Fig. 2
Fig. 2
Overall Survival
Fig. 3
Fig. 3
Progression Free Survival

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