Definitive Radiation Therapy for Stage I Non-Small-Cell Lung Carcinoma: Institutional Experience With Contemporary Conformal Planning

Abstract Purpose Surgical resection for stage I Non–Small-cell lung cancer (NSCLC) is not always feasible because of the high likelihood of medical comorbidity in this patient population. We report our experience using conventional and hypofractionated radiation therapy schedules with a conformal approach. Patients and Methods Between 1991 and 2006, 102 patients with medically or otherwise inoperable stage T1/T2 N0 NSCLC were treated with curative radiation therapy alone at our institution. Patients received a median total dose of 6600 cGy, with median daily dose fractions of 250 cGy. The following outcomes were analyzed: local failure-free survival (LFFS; time to local failure or death from any cause), time to local or distal failure or death as first event, and overall survival (OS). Local failure was defined as an increase in size on imaging studies. Toxicities were evaluated using Common Terminology Criteria for Adverse Events, version 3.0. Results Median follow-up was 20.9 months (range, 4.0–138.9 months). Median LFFS was 21.2 months (95% CI, 17.3–27.2 months), and median OS was 21.3 months (95% CI, 17.9–28.8 months). Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 15.1% (95% CI, 8.5%–23.4%), the probability of distal failure as the first detected event was 18% (95% CI, 10.9%–26.5%), and the probability of death without recording a failure was 51.6% (95% CI, 40.6%–61.5%). No patients experienced grade ≥ 4 toxicity, and only 4 patients experienced grade 3 toxicity. Conclusion Conformal radiation therapy is an effective and safe alternative to surgery for selected patients with stage I NSCLC.