Horne ZD, et al. - Researchers in this work presented their institutional outcomes of stereotactic body radiation therapy (SBRT) for hilar/mediastinal non-small cell lung cancer (NSCLC). They recognized that for the local control of isolated nodal disease, hilar/mediastinal SBRT could be a safe technique with limited toxicity from the fractionation schemes utilized.

Methods

• Researchers performed a retrospective review of patients with NSCLC in a hilar or mediastinal nodal station which was treated with SBRT.
• Patients with a lesion involving the hilum or mediastinum from primary or oligorecurrent NSCLC were reviewed.
• For outcomes analysis, they used Kaplan-Meier with log-rank testing and Cox analysis.

Results

• Researchers recognized 40 patients (median age of 70) who were treated with SBRT for primary/oligorecurrent hilar/mediastinal NSCLC from 2008–2015; median follow-up period was 16.4 months.
• Following definitive therapy, 85% presented with oligorecurrent disease at a median of 22.4 months.
• In 40% the aortico-pulmonary window was the target, in 25% the hilum was the target, in 20% lower paratracheal was the target, in 10% subcarinal was the target, and in 5% prevascular was the target .
• They noticed that the median dose was 48 Gy in 4 fractions (range: 35–48 Gy in 4–5 fractions).
• They observed median overall (OS) and progression-free (PFS) survivals of 22.7 and 13.1 months, respectively.
• Two-year local control of 87.7% was observed; this was not markedly different between hilar and mediastinal targets.
• Patients with hilar nodal targets vs mediastinal nodal targets indicated significantly improved median PFS: 33.3 vs 8.4 months, respectively (p=0.031).
• Hilar and mediastinal targets indicated no statistical differences regarding OS (p=0.359).
• Multivariable analysis suggested that hilar vs mediastinal target predicted for PFS (HR 3.045 95%CI [1.044–8.833], p=0.042), as did shorter time to presentation in patients with oligorecurrence (HR 0.983 [95%CI 0.967–1.000], p=0.049).
• They observed three patients with acute grade 3+ morbidity (hemoptysis, pericardial/pleural effusion, heart failure) and 1 patient with late grade 3+ morbidity (hemoptysis).