Session Item

To assess local control (LC) and safety of stereotactic ablative radiotherapy (SABR) in unresectable locally advanced non-small cell lung cancer (LA-NSCLC) patients enrolled in a phase II trial.

All patients were unfit for concurrent chemo-radiotherapy (ChT-cRT). Neoadjuvant ChT was prescribed only in fit patients. The tumor volume included primary tumor (T) and CT-PET positive node/s (N). A simultaneous integrated boost (SIB) was optimized to differentiate the dose for primary tumor (T) and lymph-node/s (N). 

73 LA-NSCLC patients were recruited. The median age was 73 years (range,45-89) and 51 (70%) were male. Histology was adenocarcinoma (ADK) and squamous cell carcinoma (SCC) in 56% and 44%, respectively. The stage was IIB, IIA, IIIB and oligometastatic IV in 12 (16%), 34 (47%), 18 (25%) and 9 (12%), respectively. 60 (82%) had ultra-central tumor with PTV overlapping the major airways. 43 (59%) received neoadjuvant ChT and 10 (14%) adjuvant Durvalumab. In 35 (48%) cases T and N were separately treated using SIB technique to administer a higher dose to T. Median prescribed dose was 45 Gy (range, 35-55) and 40 Gy (35-45) in 5 fractions to T and N, respectively. During a median follow-up of 20 months (range, 4-71), 20 (20%) patients had experienced local recurrence (LR) at a median time of 16 months (range, 4-30) and 24 had thoracic nodal-recurrence at a median time of 16 months (range, 4-28). 25 (34%) developed distant metastases 13 months after SABR (range, 4-26). At last follow-up, 57 (78%) patients were alive, 27 (37%) without radiological evidence of disease. No patients developed ≥ G3 acute and late toxicities. The treatment compliance was 100%.

LA-NSCLC patients treated with SABR had optimal LC and promising overall survival in absence of ≥G3 toxicity. Our prospective results provide an attraction to evaluate this approach in selected LA-NSCLC patients unfit to concurrent ChT-cRT.