Lung

Question 1

Hallmark trial RTOG 0236(Timmerman et al)

Lung SBRT Phase II multicenter study of medically inoperable patients with biopsy proven NSCLC

Answer 1

> =2 cm from TB tree
T1-T2N0M0 (<5 cm in diameter)
54Gy x 3 fnx

JAMA 2010
3 yr tumor control rate 97.6%
3 yr local(primary+lobe) tumor control rate 90.6%
3 yr DFS = 48.3% OS = 55.8%
12.7 % G3+ 3.6%G4 0% G5

ASTRO 2015
5 yr tumor control rate 93%
5 yr local(primary+lobe) tumor control rate 80%
5 yr DFS = 26% OS = 40%
Modestly more toxicity

Question 2

Standard of care for limited stage-SCLC

ASTRO 2016 lecture

Answer 2

ChemoRT followed by PCI
Addition of RT to chemo improves OS ~5%
Addition of PCI results in ~5% increase in OS in 3 years and 50% relative reduction of brain mets
RT should be initiated early with chemo(cycle 1 or 2)
ENI can be omitted in appropriately staged patients
60-70Gy/2Gy/Fnx