JOURNAL of
ONCOLOGICAL
SCIENCES

ORIGINAL RESEARCH ARTICLE

Impact of Adjuvant Chemotherapy in Patients with Medically Inoperable Non-Small Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy
Received Date : 24 Jan 2023
Accepted Date : 24 Feb 2023
Available Online : 03 Mar 2023
Doi: 10.37047/jos.2023-95681 - Article's Language: EN
J Oncol Sci.
This is an open access article under the CC BY-NC-ND license
ABSTRACT
Objective: To assess the treatment outcomes and impact of adjuvant chemotherapy on patients with early-stage medically inoperable lung cancer treated with stereotactic ablative radiosurgery (SABR). Material and Methods: The characteristics of 51 medically inoperable patients with lung cancer (T1–4 N0) who were treated with SABR and their response characteristics to the treatment were evaluated between June 2013 and June 2018. Results: The median patient age was 71 (range 48-86) years. Forty-three (84.3%) patients were men. Most patients had low-performance status (the Karnofsky Performance Scale 50-70), and 31 (60.8%) patients were aged above 65 years. The median tumor diameter was calculated as 32 (10-85) mm, and 29 (56.9%) patients had tumor diameters greater than 30 mm. The most common histology was squamous cell carcinoma (n=23, 45.1%). All patients received SABR treatment, and 12 (23.5%) patients received adjuvant chemotherapy. Disease-free survival could not be attained and overall survival (OS) was found at 32 (95% confidence interval, 21.2 to 42.8) months. Local recurrence was observed in only two (3.9%) patients. After SABR treatment, complete and partial responses were obtained in 35 (68.6%) and 15 (29.4%) patients, respectively. Significantly worse OS was observed in patients who received adjuvant chemotherapy compared to those who did not (16 and 40 months, respectively; and p=0.04). Conclusion: SABR treatment without chemotherapy could control the disease in individuals with low-performance status without any harmful side effects.
REFERENCES
  1. Timmerman R, Paulus R, Galvin J,et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA.2010;303(11):1070-1076. [Crossref]  [PubMed]  [PMC] 
  2. NCCN Clinical Practice Guidelines in Oncology. NonSmall Cell Lung Cancer(NSCLC) Version 2.2021-December 15-2020. [Link] 
  3. Louie AV, Rodrigues GB, Palma DA,Senan S. Measuring the population impact of introducing stereotactic ablative radiotherapyfor stage I non-small cell lung cancer in Canada. Oncologist. 2014;19(8):880-885. [Crossref]  [PubMed]  [PMC] 
  4. Chang JY, Liu H, Balter P, et al.Clinical outcome and predictors of survival and pneumonitis after stereotactic ablativeradiotherapy for stage I non-small cell lung cancer. Radiat Oncol. 2012;7:152. [Crossref]  [PubMed]  [PMC] 
  5. BD Smith, Jiang J, Chang JY. etal. Cost-effectiveness of stereotactic radiation, sublobar resection, and lobectomy forearly non-small cell lung cancers in older adults. J Geriatr Oncol. 2015;6(4):324-31. [Crossref]  [PubMed]  [PMC] 
  6. Gjyshi O, Xu T, Elhammali A, etal. Toxicity and survival after intensity-modulated proton therapy versus passive scatteringproton therapy for NSCLC. J Thorac Oncol. 2021;16(2):269-277. [Crossref]  [PubMed]  [PMC] 
  7. Guckenberger M, Andratschke N,Alheit H, et al; Deutschen Gesellschaft für Radioonkologie (DEGRO). Definition ofstereotactic body radiotherapy: principles and practice for the treatment of stage Inon-small cell lung cancer. Strahlenther Onkol. 2014;190(1):26-33. [Crossref]  [PubMed]  [PMC] 
  8. Baumann P, Nyman J, Hoyer M, etal. Outcome in a prospective phase II trial of medically inoperable stage I non-small-celllung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol.2009;27(20):3290-3296. [Crossref]  [PubMed] 
  9. Shultz DB, Filippi AR, Thariat J,et al. Stereotactic ablative radiotherapy for pulmonary oligometastases and oligometastaticlung cancer. J Thorac Oncol. 2014;9(10):1426-1433. [Crossref]  [PubMed] 
  10. Chang JY, Senan S, Paul MA, etal. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-celllung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630-637.Erratum in: Lancet Oncol. 2015;16(9):e427. [Crossref]  [PubMed]  [PMC] 
  11. Handforth C, Clegg A, Young C, etal. The prevalence and outcomes of frailty in older cancer patients: a systematic review.Ann Oncol. 2015;26(6):1091-1101. [Crossref]  [PubMed] 
  12. Nagata Y, Hiraoka M, Shibata T,et al. Stereotactic body radiation therapy for T1N0M0 non-small cell lung cancer: firstreport for inoperable population of a phase II trial by Japan Clinical Oncology Group (JCOG0403). International Journal of Radiation Oncology*Biology*Physics 2012;84(3):S46. [Crossref] 
  13. Widder J, Postmus D, Ubbels JF,Wiegman EM, Langendijk JA. Survival and quality of life after stereotactic or 3D-conformalradiotherapy for inoperable early-stage lung cancer. Int J Radiat Oncol Biol Phys.2011;81(4):e291-297. [Crossref]  [PubMed] 
  14. Rusthoven CG, Kavanagh BD, Karam SD. Improved survival with stereotacticablative radiotherapy (SABR) over lobectomy for early stage non-small cell lung cancer(NSCLC): addressing the fallout of disruptive randomized data. Ann Transl Med.2015;3(11):149. [PubMed]  [PMC] 
  15. Palma D, Senan S. Stereotacticradiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. CurrOpin Oncol. 2011;23(2):133-139. [Crossref]  [PubMed] 
  16. Ball D, Mai GT, Vinod S, et al;TROG 09.02 CHISEL investigators. Stereotactic ablative radiotherapy versus standardradiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3,open-label, randomised controlled trial. Lancet Oncol. 2019;20(4):494-503. [Crossref]  [PubMed] 
  17. Eguchi T, Bains S, Lee MC, et al.Impact of increasing age on cause-specific mortality and morbidity in patients with stage inon-small-cell lung cancer: a competing risks analysis. J Clin Oncol. 2017;35(3):281-290. [Crossref]  [PubMed]  [PMC] 
  18. Ernani V, Appiah AK, Marr A, etal. Adjuvant systemic therapy in patients with early-stage NSCLC treated with stereotacticbody radiation therapy. J Thorac Oncol. 2019;14(3):475-481. [Crossref]  [PubMed] 
  19. Douillard JY, Rosell R, De LenaM, et al; Adjuvant Navelbine International Trialist Association. Impact of postoperativeradiation therapy on survival in patients with complete resection and stage I, II, or IIIAnon-small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant NavelbineInternational Trialist Association (ANITA) Randomized Trial. Int J Radiat Oncol Biol Phys.2008;72(3):695-701. [Crossref]  [PubMed]