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Ann Thorac Surg 2007;83:1820-1825
© 2007 The Society of Thoracic Surgeons
a Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
b Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
c Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
d The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, Pennsylvania
e Boston Medical Center, Boston, Massachusetts
Accepted for publication November 13, 2006.
* Address correspondence to Dr Luketich, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh PA 15213 (Email: luketichjd{at}upmc.edu).
Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.
Background: Surgical resection is the standard of care for patients with resectable non-small cell lung carcinoma (NSCLC) or limited pulmonary metastases. Stereotactic radiosurgery (SRS) may offer an alternative option for high-risk patients who are not surgical candidates. We report our initial experience with SRS in the treatment of lung neoplasm.
Methods: Patients who were medically inoperable were offered SRS. Thoracic surgeons evaluated all patients, placed fiducials, and planned treatment in collaboration with radiation oncologists. A median dose of 20 Gy prescribed to the 80% isodose line was administered in a single fraction. The initial response rate, time to progression, and overall survival were evaluated.
Results: During a 2-year period, 32 patients, 27 with NSCLC and 5 with pulmonary metastases, underwent SRS. Fiducial placement resulted in a pneumothorax requiring a pigtail catheter in 9 patients (28%). An initial complete response was observed in 7 patients (22%) and partial response in 10 (31%). Disease was stable in 9 (28%) and progression occurred in 5 patients (16%), with a median time to local progression of 11 months. The median overall survival was 26 months. The probability of 1-year overall survival was 78% (95% confidence interval [CI], 65% to 94%) for the entire group and 91% (95% CI, 75% to 100%) for stage I patients.
Conclusions: Our preliminary experience indicates that SRS has reasonable results in this high-risk group of patients, with pneumothorax being a significant morbidity. Surgery continues to offer the best chance of cure for resectable patients; however, SRS offers an alternative to high-risk patients.
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