Synchronous non small cell lung cancer nodules treated with stereotactic body radiation therapy (SBRT)
Aryavarta M.S. Kumar, Neil M. Woody, Toufik Djemil, Gregory M.M. Videtic and Kevin L. Stephans
Background and Purpose: We compare our institutional outcomes of synchronous primary (SP) lung lesion patients with non-SP patients.
Materials and Methods: From an IRB approved prospective registry of 445 NSCLC patients treated with SBRT (8/2005 – 8/2012), 26 (5.8%) had SPs by biopsy or PET/CT. SBRT was delivered on a Novalis/BrainLAB platform with daily Exactrac set-up.
Results: There were no significant differences comparing SP vs non-SP groups for age, Charlson score, smoking pack years, and PET SUV (p=ns). 18 (69%) SP patients had at least one lesion biopsied. Ipsilateral and bilateral SPs were seen in 10 (38.4%) and 16 (61.6%) respectively. 77% received 50 Gy / 5 fx. SP vs non-SP median follow up was 12 (range 1.5-49.8) vs 15.2 months. Median survival for SP vs non-SP groups was 20.7 vs 28.4 months (p=0.3). In SP vs non-SP groups, local failure was 4% vs 7.6% (p=ns) and nodal/distant failure was 23% vs 24.6% (p=ns). Patients with ipsilateral and bilateral SPs had a 50% vs 14% distant failure respectively (p=0.037).
Conclusions: After SBRT, there were no differences in survival and patterns of failure for SP vs non-SP patients. Ipsilateral SPs had significantly worse distant failure compared to bilateral SPs.
Keywords: lung cancer, synchronous lesions, SBRT, non-small cell lung cancer