Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC).

BACKGROUND: Stereotactic body radiotherapy (SBRT) has been adopted as the standard of care for inoperable early-stage non-small cell lung cancer (NSCLC), with local control rates consistently >90%. However, data directly comparing the outcomes of SBRT with those of conventionally fractionated radiotherapy (CONV) is lacking. MATERIAL AND METHODS: Between 1990 and 2013, 497 patients (525 lesions) with early-stage NSCLC (T1-T2N0M0) were treated with CONV (n = 127) or SBRT (n = 398). In this retrospective analysis, five endpoints were compared, with and without adjusting for clinical and dosimetric factors. Competing risks analysis was performed to estimate and compare the cumulative incidence of local failure (LF), nodal failure (NF), distant failure (DF) and disease progression. Overall survival (OS) was estimated by the Kaplan-Meier method and compared by the Cox regression model. Propensity score (PS) matched analysis was performed based on seven patient and clinical variables: age, gender, Karnofsky performance status (KPS), histology, T stage, biologically equivalent dose (BED), and history of smoking. RESULTS: The median dose delivered for CONV was 75.6 Gy in 1.8-2.0 Gy fractions (range 60-90 Gy; median BED = 89.20 Gy) and for SBRT 48 Gy in four fractions (45-60 Gy in three to five fractions; median BED = 105.60 Gy). Median follow-up was 24.4 months, and 3-year LF rates were 34.1% with CONV and 13.6% with SBRT (p < .001). Three-year OS rates were 38.9 and 53.1%, respectively (p = .018). PS matching showed a significant improvement of OS (p = .0497) for SBRT. T stage was the only variable correlating with all five endpoints. CONCLUSION: SBRT compared to CONV is associated with improved LF rates and OS. Our data supports the continued use and expansion of SBRT as the standard of care treatment for inoperable early-stage NSCLC.

Clinical nodal staging of T1-2 tonsillar squamous cell carcinoma stratified by p16 status and implications for ipsilateral neck irradiation.

BACKGROUND AND PURPOSE: Previous studies have reported <5% incidence of contralateral nodal metastasis in patients with T1-2 tonsillar squamous cell carcinoma. We analyzed the nodal staging of T1-2 tonsillar squamous cell carcinoma stratified for p16 status, a marker of human papillomavirus positivity. MATERIALS AND METHODS: Clinical and radiographic nodal staging and p16 status of 41 T1-2 tonsillar squamous cell carcinoma patients who were treated between January 2002 and June 2009 were retrospectively analyzed. Patients with a history of prior head and neck cancer, synchronous cancers, base of tongue or soft palate invasion, or distant metastases at diagnosis were excluded. RESULTS: Of the 41 patients, 28 (68.2%) had p16+ tumors and 13 (31.7%) had p16- tumors. Seven patients (17.0%) presented with contralateral cervical nodal disease, all of whom had p16+ tumors. Furthermore, 25.0% of patients with p16+ tumors presented with contralateral cervical nodal disease compared with 0% of patients with p16- tumors. CONCLUSIONS: Patients with p16+ T1-2 tonsillar squamous cell carcinoma present with a higher incidence of contralateral nodal spread than those patients with p16- disease. This may have clinical implications when determining which patients are good candidates for ipsilateral cervical nodal irradiation.