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Original Articles: General Thoracic

Stereotactic Radiosurgery for the Treatment of Lung Neoplasm: Experience in 100 Consecutive Patients

^a Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^b Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^c University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, Pennsylvania

Accepted for publication May 7, 2009.

^_* Address correspondence to Dr Luketich, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213 (Email: luketichjd{at}upmc.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Ft Lauderdale, FL, Jan 28–30, 2008.

Background: Surgical resection is the standard of care for patients with resectable non-small cell lung cancer or selected patients with pulmonary metastases. Stereotactic radiosurgery may offer an alternative option for high-risk patients who are not surgical candidates. We report our initial experience with stereotactic radiosurgery in the treatment of lung neoplasm in 100 consecutive patients.

Methods: Patients who were medically inoperable were offered stereotactic radiosurgery. Thoracic surgeons evaluated all patients, placed fiducials, and performed treatment planning in collaboration with radiation oncologists. Initially, a median dose of 20 Gy prescribed to the 80% isodose line was administered in a single fraction, and this was subsequently increased to a total of 60 Gy in three fractions. The primary end point evaluated was overall survival.

Results: We treated 100 patients (median age, 70 years; 51 men, 49 women) with stereotactic radiosurgery: 46 (46%) with primary lung neoplasm, 35 (35%) with recurrent cancer, and 19 (19%) with pulmonary metastases. The median follow-up was 20 months. The median overall survival was 24 months. Local recurrence occurred in 25 patients. The probability of 2-year overall survival was 50% for the entire group, 44% for primary lung cancer, 41% for recurrent cancer, and 84% for metastatic cancer.

Conclusions: Our initial experience indicates that stereotactic radiosurgery has reasonable results in these high-risk patients. Resection continues to remain the standard treatment; however, stereotactic radiosurgery may offer an alternative in high-risk patients. Further prospective studies with different dose schema are needed to evaluate the efficacy of stereotactic radiosurgery.