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Radical stereotactic radiosurgery effective in inoperable early stage NSCLC

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Radical stereotactic radiosurgery effective in inoperable early stage NSCLC Patients with early stage non–small cell lung cancer that is inoperable may have a new treatment option available that provides a high percentage of OS.

Data recently presented by Eric D. Anderson, MD, FCCP, director of interventional pulmonology in the division of pulmonary, critical care and sleep medicine at Georgetown University Hospital, at the annual CHEST meeting in San Diego demonstrated that radical stereotactic radiosurgery performed with CyberKnife led to a 100% OS after three years in patients with relatively good lung function prior to treatment.

According to background information, patients with small lung tumors characterized as early-stage usually undergo lobectomy as standard of care; however, in some patients with preexisting comorbidities, such as emphysema or heart disease, surgery may not be an option.

It was in these patients that Anderson and colleagues conducted a study to evaluate whether baseline postbronchodilator percent predicted forced expiratory volume in one second — which measures a patient’s ability to exhale forcefully — affected OS.

The study enrolled 24 patients with inoperable NSCLC. Patients were treated with radical stereotactic radiosurgery for a four-year period and followed for a minimum of 12 months. Mean age of patients was 76 years and the median baseline percent predicted FEV1 postbronchodilator was 49%. Patients were followed for an average of 36 months.

OS for all patients was 79%. Five deaths occurred due to progressive lung dysfunction. Patients with better FEV1 had a 100% OS. Those patients with postbronchodilator FEV1 40% predicted OS of only 30%.

“What we also learned from this study is that patients with poorer lung functioning don’t do nearly as well,” Brian T. Collins, MD, a member of the Lombardi Comprehensive Cancer Center and director of the thoracic CyberKnife program at Georgetown University Hospital, said in a press release. “This information is important for the doctor and patients when making treatment decisions. In treating someone with severe lung dysfunction, it would seem prudent to modify the treatment dose in order to reduce further damage to the lungs that stereotactic radiosurgery causes.”