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Stereotactic boost on residual disease after external-beam irradiation in clinical stage III non-small cell lung cancer: mature results of stereotactic body radiation therapy post radiation therapy (SBRTpostRT) study

  • Radiotherapy
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Abstract

Purpose

To evaluate the role of stereotactic body radiation therapy (SBRT) delivered after external-beam fractionated irradiation in non-small-cell lung cancer (NSCLC) patients with clinical stage III A, B.

Materials and methods

All patients received three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) (60–66 Gy/30–33 fractions of 2 Gy/5 days a week) with or without concomitant chemotherapy. Within 60 days from the end of irradiation, a SBRT boost (12–22 Gy in 1–3 fractions) was delivered on the residual disease.

Results

Here we report the mature results of 23 patients homogeneously treated and followed up for a median time of 5.35 years (range 4.16–10.16). The rate of overall clinical response after external beam and stereotactic boost was 100%. No treatment-related mortality was recorded. Radiation-related acute toxicities with a grade ≥ 2 were observed in 6/23 patients (26.1%): 4/23 (17.4%) had esophagitis with mild esophageal pain (G2); in 2/23 (8.7%) clinical radiation pneumonitis G2 was observed. Lung fibrosis (20/23 patients, 86.95%) represented a typical late tissue damage, which was symptomatic in one patient. Median disease-free survival (DFS) and overall survival (OS) were 27.8 (95% CI, 4.2–51.3) and 56.7 months (95% CI, 34.9–78.5), respectively. Median local progression-free survival (PFS) was 17 months (range 11.6–22.4), with a median distant PFS of 18 months (range 9.6–26.4). The 5-year actuarial DFS and OS rates were 28.7% and 35.2%, respectively.

Conclusions

We confirm that a stereotactic boost after radical irradiation is feasible in stage III NSCLC patients. All fit patients who have no indication to adjuvant immunotherapy and presenting residual disease after curative irradiation could benefit from stereotactic boost because outcomes seem to be better than might be historically assumed.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Silvana Parisi and Gianluca Ferini: Co-first authors.

  2. Alberto Cacciola and Stefano Pergolizzi: Co-last authors.

Authors and Affiliations

  1. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Silvana Parisi, Sara Lillo, Federico Chillari, Giacomo Ferrantelli, Antonio Pontoriero, Fabio Minutoli, Antonio Bottari, Alberto Cacciola & Stefano Pergolizzi

  2. REM Radioterapia Srl, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy

    Gianluca Ferini

  3. Medical Physics Unit, A.O.U. “G. Martino”, Messina, Italy

    Anna Brogna

  4. Radiation Oncology Unit, Papardo Hospital, Messina, Italy

    Nicola Settineri, Anna Santacaterina, Angelo Platania & Salvatore Leotta

  5. Thoracic Surgery Unit, Papardo Hospital, Messina, Italy

    Giuseppe Casablanca

  6. Medical Oncology Unit, Papardo Hospital, Messina, Italy

    Alessandro Russo & Vincenzo Adamo

  7. Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Bei**g, China

    Sara Lillo

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  1. Silvana Parisi
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Correspondence to Sara Lillo.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee of University of Messina with protocol number 0003722.

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Parisi, S., Ferini, G., Lillo, S. et al. Stereotactic boost on residual disease after external-beam irradiation in clinical stage III non-small cell lung cancer: mature results of stereotactic body radiation therapy post radiation therapy (SBRTpostRT) study. Radiol med 128, 877–885 (2023). https://doi.org/10.1007/s11547-023-01659-w

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