Biologically Effective Dose in Stereotactic Body Radiotherapy and Survival for Patients With Early-Stage NSCLC

Amy C. Moreno, Bryan Fellman, Brian P. Hobbs, Zhongxing Liao, Daniel R. Gomez, Aileen Chen, Stephen M. Hahn, Joe Y. Chang, Steven H. Lin

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Introduction: Stereotactic body radiotherapy (SBRT) results in excellent local control of stage I NSCLC. Radiobiology models predict greater tumor response when higher biologically effective doses (BED10) are given. Prior studies support a BED10 greater than or equal to 100 Gy with SBRT; however, data are limited comparing outcomes after various SBRT regimens. We therefore sought to evaluate national trends and the effect of using “low” versus “high” BED10 SBRT courses on overall survival (OS). Methods: This retrospective study used the National Cancer Data Base to identify patients diagnosed with clinical stage I (cT1-2aN0M0) NSCLC from 2004 to 2014 treated with SBRT. Patients were categorized into LowBED (100-129 Gy) or HighBED (≥130 Gy) groups. A 1:1 matched analysis based on patient and tumor characteristics was used to compare OS by BED10 group. Tumor centrality was not assessed. Results: O 25,039 patients treated with LowBED (n = 14,756; 59%) or HighBED (n = 10,283; 41%) SBRT, 20,542 were matched. Shifts in HighBED to LowBED SBRT regimen use correlated with key publications in the literature. In the matched cohort, 5-year OS rates were 26% for LowBED and 34% for HighBED groups (p = 0.039). On multivariate analysis, receipt of LowBED was associated with significantly worse survival (hazard ratio = 1.046, 95% confidence interval: 1.004–1.090, p = 0.032). Conclusions: LowBED SBRT for treating stage I NSCLC is becoming more common. However, our findings suggest SBRT regimens with BED10 greater than or equal to 130 Gy may confer an additional survival benefit. Additional studies are required to evaluate the dose-response relationship and toxicities associated with modern HighBED SBRT.

Original languageEnglish (US)
Pages (from-to)101-109
Number of pages9
JournalJournal of Thoracic Oncology
Volume15
Issue number1
DOIs
StatePublished - Jan 2020

Keywords

  • Biologically effective dose
  • Early-stage lung cancer
  • NSCLC
  • Stereotactic ablative radiation therapy
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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