Stereotactic body radiation beats standard treatment

Stereotactic body radiation beats standard treatment

2/12/2013

CHICAGO -- The use of newer stereotactic body radiation therapy (SBRT) appears to give patients with inoperable non-small cell lung cancer significantly improved outcomes when compared with the former technology of choice, conventionally fractioned radiotherapy (CFR), researchers suggested here.

In a retrospective study, 27 of 33 patients who underwent CFR achieved local control of their cancer, compared with 48 of 50 patients undergoing SBRT, a difference that achieved statistical significance (P=0.0344), reported Mohammed Jaffar, BS, a third-year medical student at the University of Central Florida School of Medicine in Orlando.

"We wanted to test whether SBRT -- aside from being the newest toy on the street -- was also a more effective way to treat these people," Jaffar told MedPage Today at the annual meeting of the Radiological Society of North America.

He and his colleagues also reported that 15 of the 33 CFR-treated patients died of their disease compared with 11 of the 50 SBRT patients, also significant (P=0.0002).

Jaffar said he did not observe any difference in mortality at 2 years, but by 5 years the survival curves began to separate so that there was a significant difference in survival for those undergoing SBRT (P=0.0037).

A higher percentage of patients reported no adverse effects of the SBRT therapy when compared with CFR, but he said the difference was not statistically significant (P=0.381). Grade 3 and grade 4 adverse events were uncommon.

"Overall results suggest that significant advantages are to be attained if one is treated with SBRT as opposed to CFR in non-small cell lung cancer," Jaffar said.

In his oral presentation, he noted that although the first line of treatment for non-small cell lung cancer is lobectomy, the demographics of the population diagnosed with the disease make performing the surgery problematic. About 70% of those persons diagnosed with non-small cell lung cancer are over the age of 65, and many of these patients are inoperable due to heart, lung, kidney, and other comorbidities, he said.

Beginning in the 1970s, patients with inoperable disease were treated with CFR -- 5 fractions of 2 Gy a week for 4 to 6 weeks. In the 2000s, SBRT was introduced for treatment of inoperable non-small cell lung cancer, and the profession gradually transitioned to the new modality that delivered 3 to 5 fractions a week in a 2-week treatment period.

"We have mostly transitioned to SBRT," session co-moderator Matthew Harkenrider, MD, of the Loyola University Chicago Stritch School of Medicine, told MedPage Today.

"The study confirms that SBRT may be a preferred treatment method," said Zhongxing Liao, MD, of the University of Texas MD Anderson Cancer Center, Houston. "However, I would still like to see how the SBRT figures pan out after 5 years. Those curves may close,".

Jaffar said his research in the same topic will look to see if there are differences in specific subsets of patients, including a comparison of lobectomy with SBRT.

 

Source: MedPage Today: http://www.medpagetoday.com/MeetingCoverage/RSNA/43204