Important Studies Flashcards
SBRT vs. EBRT?
CHISEL (Ball et al, Lancet Oncol, 2019): SBRT improved LC and OS compared to conventional RT. Similar toxicity.
SPACE (Nyman et al, Radiother Oncol, 2016): SBRT has less toxicity than conventional radiation. SBRT has a trend toward less progression. There is no change in PFS or OS.
SBRT followed by Surgery?
MISSILE (Palma et al, JAMA Oncol, 2019): SBRT→ VATS lobectomy or sublobar resection after 10 weeks
With SBRT followed by VATS resection, the pCR rate was lower than expected. Toxicity and post op deaths were similar to surgical series.
SBRT dose for peripheral tumors?
RTOG 0236 (Timmerman et al, JAMA, 2010): Phase II: SBRT to 60 Gy/3 fx (closer to 54Gy/3 fx using heterogeneity corrections) rx to periphery. SBRT for peripheral lung lesions is feasible and results in high LC and LRC. Additional recurrences can occur with longer follow-up.
RTOG 0618 (Timmerman et al, JAMA Oncol, 2018): Phase II: 54 Gy/3 fx in 1.5-2 weeks. SBRT has high tumor control and low toxicity.
NRG/RTOG 0915 (Videtic et al, IJROBP, 2015): Phase II randomized: →34 Gy/1 fx vs. →48 Gy/4 fx (Japanese), daily fx. Primary endpoint: goal grade ≥3 adverse events <17% and LC >90% at 1 year. Both fractionations met the prespecified endpoints and warrant further testing.
Roswell Park Comprehensive Cancer (Singh et al, IJROBP, 2019): Phase II randomized: →30 Gy/1 fx vs. →60 Gy/3 fx. Single fraction lung SBRT is equivalent to 3 fractions for peripheral lesions.
SBRT dose for central tumors?
RTOG 0813 (Bezjak et al, JCO, 2019): Dose escalation: 10, 10.5, 11, 11.5, 12 Gy SBRT x 5 fx. Endpoint: 1-yr grade 3+ toxicity <20%. The highest dose level allowed, 12 Gy x 5 fx, was tolerated as defined by the predetermined endpoint of 1 year with high LC. However after 1 year there were deaths with 11.5 and 12 Gy.
SABR vs. surgery (pro SABR)?
STARS and ROSEL (Chang et al, Lancet, 2015): SABR vs. lobectomy with MS LND or sampling. Combined analysis two studies, STARS and ROSEL, that were terminated due to slow accrual. 3-yr OS 95% SABR vs. 79% (one died SABR vs. six in surgery, p=0.037)
SABR vs. surgery (ongoing)?
STABL-MATES and VALOR
SABR vs. surgery (pro surgery)
London Health Sciences Centre, London, Ontario, Canada (Chen et al, IJROBP, 2018): Meta-analysis of 16 propensity matched studies comparing SABR and surgery. There was better OS with surgery compared to RT in this large database retrospective analysis. CSS was not different.
Lobectomy vs wedge?
Lung Cancer Study Group 821 (Ginsberg et al, Ann Thorac Surg, 1995): Improved LC with lobectomy 6% vs. 18%. Trend to increase in overall death and cancer death with wedge resection”
