Stereotactic body radiation therapy for primary lung cancers >3 centimeters.

Introduction: A retrospective analysis of the outcomes of stereotactic body radiation therapy (SBRT) in the treatment of large (>3 cm) non-small-cell lung cancers (NSCLCs).
Methods: Between February 2007 and November 2011, 63 patients with T2-T4N0 NSCLC were treated with SBRT. Toxicity was graded per Common Terminology Criteria for Adverse Events, version 4.0. Local failure-free survival (LFFS), recurrence-free survival, and overall survival curves were estimated using the Kaplan-Meier method and univariate analysis was performed using Cox regression.
Results: Median follow-up was 16.9 months. One- and 2-year LFFS was 88.8% and 75.7%, 1- and 2-year recurrence-free survival was 59.0% and 41.6%, and 1- and 2-year overall survival was 77.1% and 57.6%, respectively. Planning target volume less than 106 cm was associated with a significantly higher 1- and 2-year LFFS (p =0.05). Grade 2 or higher acute and late pulmonary toxicities occurred in 19.3% and 19.3% of patients, respectively, and were not associated with common dose-volume parameters; 22.8% of patients developed grade 2 or higher chest wall pain, which was significantly associated with chest wall V30 70 cm or more (p = 0.03).
Conclusions: SBRT for larger NSCLC tumors achieves high LFFS with acceptable toxicity. LFFS was worse with planning target volume 106 cm or more. Grade 2 or higher chest wall pain was associated with chest wall V30 70 cm or more.