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Stereotactic vs Hypofractionated Radiotherapy for Inoperable Stage I Non-Small Cell Lung Cancer: The LUSTRE Phase 3
Anand Swaminath1, Sameer Parpia2, Marcin Wierzbicki3
1Department of Oncology, McMaster University, and the Division of Radiation Oncology Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada.
JAMA Oncology
|September 19, 2024
Summary
Stereotactic body radiotherapy (SBRT) showed similar local control to conventional radiotherapy (CRT) for stage I non-small cell lung cancer (NSCLC). This study found no significant difference in survival or severe toxicity between SBRT and CRT for NSCLC patients.
Area of Science:
- Radiation Oncology
- Medical Physics
- Thoracic Surgery
Background:
- Stereotactic body radiotherapy (SBRT) is a standard treatment for medically inoperable stage I non-small cell lung cancer (NSCLC).
- However, randomized clinical trials (RCTs) have yielded varied results, particularly concerning the treatment of centrally located tumors.
Purpose of the Study:
- To compare the effectiveness of SBRT versus conventional radiotherapy (CRT) in improving local control (LC) for stage I NSCLC.
- To evaluate secondary outcomes including event-free survival, overall survival, and treatment-related toxic effects.
Main Methods:
- A phase 3 randomized clinical trial (RCT) involving 16 Canadian centers.
- Patients with medically inoperable stage I NSCLC were randomized 2:1 to receive either SBRT (48 Gy in 4 fractions for peripheral, 60 Gy in 8 fractions for central tumors) or CRT (60 Gy in 15 fractions).
- Local control at 3 years was the primary endpoint, with a target sample size of 324 patients.
Main Results:
- The 3-year local control rate was 87.6% for SBRT and 81.2% for CRT (Hazard Ratio [HR] 0.61; P=.15), showing no statistically significant difference.
- Event-free survival (HR 1.02; P=.87) and overall survival (HR 1.18; P=.40) were also similar between the groups.
- Severe toxic effects were limited, though one possible grade 5 event (hemoptysis) occurred in a patient treated with SBRT for an ultracentral lesion.
Conclusions:
- This RCT found no significant difference in 3-year local control between SBRT and CRT for stage I NSCLC.
- Both treatment modalities demonstrated acceptable toxicity profiles, even for central tumors.
- Further research is needed to definitively establish SBRT's superiority over CRT for both peripheral and central NSCLC.
