In a study reported in JAMA Oncology, David A. Palma, MD, PhD, and colleagues found that stereotactic ablative radiotherapy (SABR) met criteria for efficacy and toxicity in patients with early non–small cell lung cancer (NSCLC) and interstitial lung disease (ILD).
As stated by the investigators, “Patients with ILD and early-stage NSCLC have been reported to be at high risk of toxic effects after SABR, but for many patients, there are limited alternative treatment options.”
David A. Palma, MD, PhD
Study Details
Thirty-nine patients with fibrotic ILD and T1-2N0 NSCLC who were not candidates for surgical resection were enrolled in the study between March 2019 and January 2022 from five sites in Canada and one in Scotland. SABR was given at up to 50 Gy in five fractions every other day. The study prespecified that SABR would be considered worthwhile if the median overall survival (primary endpoint) was longer than 1 year, grade 3 or 4 adverse events occurred in < 35% of patients, and grade 5 events occurred in > 15%. Overall survival at 1 year was expected to exceed by 20%, compared with a historical control rate of 50%. Patients had a median age of 78 years (interquartile range [IQR] = 67–83 years).
Key Findings
Median follow-up was 19 months (IQR = 14–25 months).
Overall survival at 1 year was 79% (95% confidence interval [CI] = 62%–89%, P < .001 vs the 50% control rate), and median overall survival was 25 months (95% CI = 14 months to not reached).
Progression-free survival at 1 year was 74% (95% CI = 57%–85%) and median progression-free survival was 19 months (95% CI = 13–28 months). At 2 years, the local control rate was 92% (95% CI = 69%–98%), the regional control rate was 86% (95% CI = 60%–95%), and the distant control rate was 91% (95% CI = 64%–98%).
Adverse events (highest grade per patient) were grade 1 or 2 in 12 patients (31%), grade 3 in 4 (10%), grade 4 in 0 (0%), and grade 5 in 3 (7.7%); all deaths were due to respiratory deterioration.
The investigators concluded, “In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits.”
Dr. Palma, of the Department of Radiation Oncology, London Health Sciences Centre, Ontario, Canada, is the corresponding author for the JAMA Oncology article.
Disclosure: This study was funded by a philanthropic donation through the London Health Sciences Foundation and a grant from the Ontario Institute for Cancer Research through funding provided by the Government of Ontario. For full disclosures of the study authors, visit jamanetwork.com.
