A retrospective study of clinicopathologic and molecular features of inoperable early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy
Journal
Journal of the Formosan Medical Association
Date Issued
2021-01-01
Author(s)
Lee, I. Han
Chen, Guann Yiing
Chien, Chun Ru
Abstract
© 2020 Formosan Medical Association Background/Purpose: Stereotactic ablative radiotherapy (SABR) is the treatment of choice for medically inoperable, early-stage non-small cell lung cancer (ES-NSCLC). The influence of oncogenic driver alterations and comorbidities are not well known. Here we present treatment outcomes based on clinicopathologic features and molecular profiles. Methods: We retrospectively analyzed patients treated with SABR for inoperable ES-NSCLC. Molecular features of oncogenic driver alterations included EGFR, ALK, and ROS1. Comorbidities were assessed using the age-adjusted Charlson Comorbidity Index (ACCI). Survival was calculated using the Kaplan–Meier method. The Cox regression model was performed for univariate and multivariate analyses of prognostic factors. Competing risk analysis was used to evaluate the cumulative incidence of disease progression. Results: From 2008 to 2020, 100 patients (median age: 82 years) were enrolled. The majority of patients were male (64%), ever-smokers (60%), and had adenocarcinoma (65%). With a median follow-up of 21.5 months, the median overall survival (OS) and real-world progression-free survival were 37.7 and 25.1 months, respectively. The competing-risk-adjusted 3-year cumulative incidences of local, regional, and disseminated failure were 8.2%, 14.5%, and 31.2%, respectively. An ACCI ≥7 was independently associated with inferior OS (hazard ratio [HR] 2.45, p = 0.03). Tumor size ≥4 cm (HR 4.16, p < 0.001) was the most important independent prognostic factor predicting real-world progression. EGFR mutation status had no impact on the outcomes. Conclusion: SABR provides excellent local control in ES-NSCLC, although disseminated failures remains a major concern. ACCI is the best indicator for OS, while tumor sizes ≥4 cm predicts poor disease control.
Subjects
Inoperable early-stage | Non-small cell lung cancer | Oncogenic driver alteration | Prognostic factor | Stereotactic ablative radiotherapy
SDGs
Other Subjects
antineoplastic metal complex; epidermal growth factor receptor; fluorodeoxyglucose f 18; paclitaxel; pemetrexed; protein tyrosine kinase inhibitor; UFT; vinorelbine tartrate; oncoprotein; protein tyrosine kinase; adjuvant chemotherapy; adjuvant therapy; adult; aged; alk gene; Article; bronchiectasis; cancer combination chemotherapy; cancer control; cancer growth; cancer mortality; cancer patient; cancer prognosis; cancer radiotherapy; cancer risk; cancer size; cancer specific survival; cancer staging; Charlson Comorbidity Index; clinical feature; clinical outcome; cohort analysis; comorbidity; controlled study; coughing; cumulative incidence; disease exacerbation; dyspnea; early cancer; esophagus disease; exon; female; follow up; gene fusion; gene rearrangement; general condition deterioration; gross tumor volume; heart failure; hemoptysis; histopathology; human; inoperable cancer; interstitial pneumonia; Karnofsky Performance Status; lung adenocarcinoma; lung complication; lung injury; major clinical study; male; mortality rate; neurological complication; never smoker; non small cell lung cancer; oncogene; overall survival; point mutation; positron emission tomography; progression free survival; radiation dose fractionation; radiation hazard; radiation pneumonia; re-irradiation; response evaluation criteria in solid tumors; retrospective study; risk assessment; ros1 gene; salvage therapy; smoking; squamous cell lung carcinoma; stereotactic body radiation therapy; survival rate; systemic therapy; thorax disease; treatment failure; tumor volume; very elderly; lung tumor; non small cell lung cancer; pathology; radiosurgery; treatment outcome; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Neoplasm Staging; Protein-Tyrosine Kinases; Proto-Oncogene Proteins; Radiosurgery; Retrospective Studies; Treatment Outcome
Type
journal article