Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non–Small Cell Lung Cancer

作者：David A. Palma, Timothy K. Nguyen, Alexander V. Louie, Richard Malthaner, Dalilah Fortin, George Rodrigues, Brian Yaremko, Joanna Laba, Keith Kwan, Stewart Gaede, Ting Lee, Aaron D. Ward, Andrew Warner, Richard Inculet · 发表于：JAMA Oncology · 年份：2019 · DOI：10.1001/jamaoncol.2018.6993 · 被引用次数：86 · 研究领域：Lung Cancer Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis、Advanced Radiotherapy Techniques

IMPORTANCE: Stereotactic ablative radiotherapy (SABR) is a standard treatment option in patients with medically inoperable early-stage non-small cell lung cancer (NSCLC), yet the pathologic complete response (pCR) rate after SABR is unknown. Neoadjuvant SABR in patients with cancer who are fit for resection has been hypothesized to improve local control and induce antitumor immune activity, potentially leading to better outcomes. OBJECTIVES: To determine the pCR rate after SABR and to assess oncologic and toxicity outcomes after a combined approach of neoadjuvant SABR followed by surgery. DESIGN, SETTING, AND PARTICIPANTS: A phase 2, single-arm trial, with patient accrual from September 30, 2014, to August 15, 2017 (median follow-up, 19 months), was performed at a tertiary academic cancer center. Patients 18 years or older with T1T2N0M0 NSCLC and good performance status, with adequate pulmonary reserve to undergo surgical resection, were studied. INTERVENTIONS: Patients underwent neoadjuvant SABR using a risk-adapted fractionation scheme followed by surgery 10 weeks later. MAIN OUTCOMES AND MEASURES: The pCR rate as determined by hematoxylin-eosin staining. RESULTS: Forty patients (mean [SD] age, 68 [8] years; 23 [58%] female) were enrolled. Thirty-five patients underwent surgery and were evaluable for the primary end point. The pCR rate was 60% (95% CI, 44%-76%). The 30- and 90-day postoperative mortality rates were both 0%. Grade 3 or 4 toxic effects occurred in 7 patients ...