Scandinavian researchers have reported that steriotactic radiotherapy for Stage I non–small cell lung cancer (NSCLC) is associated with a local control rate of 90% in patients deemed medically inoperable. These results were published in the July 10, 2009 issue of the Journal of Clinical Oncology.[1]

Radiation therapy is the treatment of choice for inoperable patients or patients who refuse surgery for Stage I NSCLC. There have been many improvements in the delivery of radiotherapy over the past two decades, including steriotactic radiation therapy and intensity modulated radiotherapy (IMRT), which deliver more radiation with fewer side effects to healthy cells. In addition, there have been developments in treating Stage I NSCLC with photons and carbon ion beam therapy as well as radiofrequency ablation combined with radiation therapy. Researchers from Germany have recently reported that single-dose stereotactic radiotherapy is associated with a 69% 36-month local control rate in patients with Stage I-II NSCLC. Other recent studies have suggested that local control rates achieved by radiotherapy approach those achieved with surgery for patients with Stage I NSCLC.

The current multicenter trial was carried out in Sweden, Denmark, and Norway and included 57 patients with Stage I NSCLC. Seventy percent had T1 disease, and 30% had T2 disease. All received three doses of steriotactic radiation at a dose of 15 GY each. The median follow-up of this study was 34 months. Local relapse was observed in 7% of patients and regional relapse in 5%. An additional 16% had distant metastases. The risk of failure at all sites was 41% for T2 and 18% for T1 tumors. Cancer-specific survival was 93% at one year, 88% at two years, and 88% at three years. Overall survival at one year was 86%, 65% at two years, and 60% at three years. These authors suggested that these results in medically inoperable patients may be comparable to surgery in medically operable patients with Stage I NSCLC.

Comments: These data confirm other studies suggesting that radiation therapy is very effective in preventing local relapses in patients with Stage I NSCLC. More patients with Stage I NSCLC die of non-cancer-related causes than from lung cancer.

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