Stereotactic body radiation therapy for nonmetastatic lung cancer: an analysis of 75 patients treated over 5 years.

PURPOSE: Non-small-cell lung cancer (NSCLC) may not be medically operable even in patients with surgically resectable disease. For patients who either refuse surgery or are medically inoperable, radiation therapy may be the best therapeutic choice. Stereotactic body radiation therapy (SBRT) employs external fixation and hypofractionation to deliver a high dose per fraction of radiation to a small target volume. METHODS AND MATERIALS: Retrospective review of 75 patients treated over 5 years at Staten Island University Hospital as definitive treatment for NSCLC or presumed NSCLC. Patients received a median of 5 fractions of 8 Gy per fraction over 27 days. RESULTS: Overall 1-, 2-, and 5-year actuarial survivals were 63%, 45%, and 17%. Patients with a gross tumor volume (GTV) less than 65 cm3 enjoyed a longer median survival (25.7 vs. 9.9 months, p < 0.003), and at 5 years, the actuarial survival for the patients with GTVs less than 65 cm3 was 24% vs. 0% for those with GTVs larger than 65 cm3. CONCLUSIONS: Stereotactic body radiation therapy as delivered was ineffective for curing the patients whose GTVs were larger than 65 cm3. SBRT was promising for those with GTVs less than 65 cm3.

Definitive, high-dose-per-fraction, conformal, stereotactic external radiation for renal cell carcinoma.

INTRODUCTION: Localized renal cell carcinoma is conventionally treated surgically. Preoperative and adjuvant external radiation have not improved survival. However, renal cell cancer brain metastases, although radioresistant to conventional external radiation, have been responsive to radiosurgery. The following report was compiled with information from our experience using high-dose-per-fraction, conformal radiation delivered to patients who refused definitive surgery. MATERIALS AND METHODS: Nine patients with nonmetastatic renal cell carcinomas were identified, 2 of which had bilateral renal cell cancers. Patients were treated definitively with 40 Gy in 5 fractions using conformal external radiation. RESULTS: With a median follow up of 26.7 months, 4 of the 9 patients are alive. The survivors have a minimum follow up of 48 months. At presentation, all 4 of the survivors had tumors < or =3.4 cm in largest dimension, had clinically negative nodes, and presented no clinical evidence of penetration of Gerota fascia or renal vein extension. CONCLUSION: High-dose-per-fraction, conformal external radiation may have a curative role for small, node-negative, organ-confined renal cell carcinomas.