Dose-individualized stereotactic body radiotherapy for T1-3N0 non-small cell lung cancer: long-term results and efficacy of adjuvant chemotherapy.

PURPOSE

To evaluate the efficacy of dose-individualized stereotactic body radiotherapy (SBRT) and adjuvant chemotherapy in stage T1-3N0M0 non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Sixty-five patients with T1-3N0M0 NSCLC treated by SBRT between April 2001 and August 2005 were included. Twenty patients were CT-staged at stage T1, 34 at stage T2, and 11 at stage T3. All patients underwent no elective nodal irradiation. SBRT total doses ranged from 71.8 to 115.2Gy of biological equivalent dose (BED) in 3.6 to 8.0Gy daily fractions. Seventeen patients were offered cisplatin-containing adjuvant chemotherapy.

RESULTS

The overall response rate was 90.6% at six months. The 3- and 5-year overall survival rates for all patients were 57.3% and 35.1%, respectively, and for stage T1-2 patients these were 60.2, 36.5%, respectively. Of all patients, the 3- and 5-year overall survival rates of adjuvant chemotherapy group were 80.5% and 46.0%, respectively, and those of patients with SBRT alone were 49.6% and 31.5%, respectively. Patients who accepted adjuvant chemotherapy had a lower relapse rate and better overall survival. Acute toxicities were mild, and no long-term toxicity was observed.

CONCLUSIONS

Patients treated with the dose-individualization strategy of SBRT showed excellent local control and improved survival. Adjuvant chemotherapy may reduce the frequency of relapse and increase overall survival in stage at T1-3N0M0 NSCLC patients.