of Press Release.
A new analysis of records in the Veteran’s
Affairs Central Cancer Registry demonstrates a clear positive impact of the
increased use of stereotactic body radiation therapy (SBRT) to treat patients
with stage I non-small cell lung cancer (NSCLC) in recent years, according to
research presented today at the 58th Annual Meeting of the American Society for
Radiation Oncology (ASTRO). Escalated adoption of this advanced form of
radiation therapy (RT) from 2001 to 2010 was associated with substantial
increases in overall survival (OS) rates and lung cancer specific survival
“Lung cancer causes more than one million deaths each
year worldwide,” said Matthew Boyer, MD, PhD, lead author of the study and a
resident in radiation oncology at Duke University in Durham, North Carolina.
“Moreover, an increasing number of localized, or stage I, lung cancer
diagnoses are occurring, due to an aging population and advanced screening
While the majority of patients with stage I NSCLC
underwent surgery, RT is recommended for patients who cannot tolerate surgery
or desire non-surgical management. SBRT, which was developed in the 1990’s,
uses advanced imaging techniques to deliver highly-targeted radiation to a
tumor and limit damage to surrounding tissue. Preserving healthy tissue is
particularly important for NSCLC patients, whose tumors are located near or in
essential organs including the heart and lungs.
Researchers sought to
determine whether the increased use of SBRT in recent years had a subsequent
impact on the outcomes of patients with NSCLC. Using the Veteran’s Affairs
Central Cancer Registry (VACCR), they identified more than 14,000 patients
diagnosed with stage I NSCLC from 2001 to 2010, including 3,012 records of
patients who received RT as their primary treatment. From this cohort, 468
patients were identified who had SBRT and 1,203 patients who received
conventional RT (i.e., the CRT group). Data regarding fractionation,
co-morbidities, treatment toxicity, PET utilization and vital status were
obtained from the VA Corporate Data Warehouse (VACDW).
outcomes included rates of overall survival (OS) and lung cancer specific
survival (LCSS) measured at four years following RT. Researchers computed
hazard ratios (HR) to compare OS and LCSS rates and changes in survival rates
between the SBRT and CRT groups as well as employed multivariate analysis to
assess the influence of participant characteristics on survival outcomes.
The average age of study participants was 72, and 98.6 percent of
patients were male. At the time of diagnosis, nearly nine in 10 patients (89.4
percent) were current or former smokers. In terms of disease type, 50.5
percent of patients were diagnosed with stage IA NSCLC, and 41.5 percent were
diagnosed with squamous cell carcinoma.
Average survival rates for
all patients increased over the study period, as did the use of SBRT. Four
year OS for study participants as a whole who underwent radiation rose from
12.7 percent to 28.5 percent and four year LCSS rose from 33.9 percent to 50.4
percent, concurrent with increased utilization of SBRT from 4.7 percent to
At four years follow-up, both overall and lung cancer
specific survival rates were significantly higher for SBRT patients than for
CRT patients. By Kaplan Meier analysis, four-year OS was 37.0 percent for SBRT
patients, which was significantly higher than the 18.8 percent OS rate for CRT
patients (HR, 0.60; p < 0.001). This improvement in OS was largely
due to an increase in LCSS which, at four years, was 53.2 percent for patients
treated with SBRT as compared to 28.3 percent for patients treated with CRT
(HR, 0.39; p < 0.001).
On multivariate analysis, treatment
with SBRT vs. CRT was associated with a nearly 30 percent reduction in the
risk of death (HR, 0.72; p < 0.001). In addition, older age (HR,
1.01 per year; p = 0.022), higher Charlson co-morbidity score (HR, 1.52
for a score of 2 vs. 0; p < 0.001), and higher stage (HR, 1.39 for
Stage IB vs. IA; p < 0.001) were associated with improved survival.
Notably, there was no significant difference in survival on multivariate
analysis based on receipt of PET scans for staging (HR, 0.88; p =
0.084) or treatment era (HR, 0.93 for 2006-2010 vs. 2001-2005; p =
0.317), indicating that the doubling in survival for patients receiving
radiation was strongly correlated with increased utilization of SBRT and not
with improved staging with PET scans or other improvements in treatment and
care over the same time period.
“It is very rare for a study to show
that double the number of patients were likely to be alive at four years due
to the introduction of a new treatment,” said Dr. Boyer. “We identified that
this doubling was due to the introduction of these advanced radiation
techniques collectively termed stereotactic body radiation therapy, or SBRT.
These findings of improved survival in stage I lung cancer patients in
general, and those undergoing radiation specifically, are generalizable to
patients outside the VHA. Although a number of studies are underway to define
the best treatment for stage I non-small cell lung cancer, our study, and
others, indicate that advances in radiation treatment and delivery can improve
patient survival and that SBRT should be the standard treatment for patients
treated with radiation for stage I NSCLC.”
The abstract, “Survival with
Stereotactic Body Radiation Therapy (SBRT) and Conventional Radiation Therapy
(CRT) in Stage I NSCLC Patients in the Veterans Health Administration,” will be
presented in detail during a scientific session at ASTRO’s 58th Annual Meeting
at 1:15 p.m. Eastern time on Sunday, September 25, 2016. To speak with Dr.
Boyer or obtain a copy of the study abstract, please contact ASTRO’s media
relations team on-site at the Boston Convention and Exhibition Center
September 25 through 28, by phone at 703-286-1600 or by email.
ATTRIBUTION TO THE AMERICAN SOCIETY OF RADIATION ONCOLOGY (ASTRO)
ANNUAL MEETING REQUESTED IN ALL COVERAGE.
This news release contains updated data from the study
ABOUT ASTRO’S ANNUAL MEETING
Annual Meeting, the nation’s premier scientific meeting in radiation oncology,
will be held September 25-28, 2016, at the Boston Convention and Exhibition
Center in Boston. The 2016 Annual Meeting is expected to attract more than
11,000 attendees from across the globe, including oncologists from all
disciplines and members of the entire radiation oncology team. Led by ASTRO
president David C. Beyer, MD, FASTRO, the 2016 meeting will feature keynote
addresses from Kathleen Sebelius, former U.S. Secretary of Health and Human
Services; Thomas James Lynch Jr., MD, Chair and CEO, Massachusetts General
Physicians Organization; and Jason Ragogna, general manager, SMS and Safety
Alliances, Corporate Safety, Security, and Compliance, Delta Air Lines, Inc.
The Presidential Symposium, “Prostate Cancer: Defining Value and Delivering
It,” highlights the meeting’s theme of “Enhancing Value, Improving Outcomes”
and will feature recent practice-changing studies and current developments in
value-based care for prostate cancer. ASTRO’s four-day scientific meeting will
feature a record number of abstracts, including 368 oral presentations, 1,760
posters and 180 digital posters in more than 50 educational sessions and 20
scientific panels for 20 disease-site tracks. For more information about
ASTRO’s 58th Annual Meeting, visit www.astro.org/AnnualMeeting.
For press registration and news briefing information for ASTRO’s 58th Annual
Meeting, visit www.astro.org/AMPress.
ASTRO is the premier radiation oncology society
in the world, with more than 10,000 members who are physicians, nurses,
biologists, physicists, radiation therapists, dosimetrists and other health
care professionals who specialize in treating patients with radiation
therapies. As the leading organization in radiation oncology, the Society is
dedicated to improving patient care through professional education and
training, support for clinical practice and health policy standards,
advancement of science and research, and advocacy. ASTRO publishes three
medical journals, International Journal of Radiation Oncology • Biology •
Physics (www.redjournal.org), Practical
Radiation Oncology (www.practicalradonc.org)
and Advances in Radiation Oncology (www.advancesradonc.org);
developed and maintains an extensive patient website, RT Answers
created the Radiation Oncology Institute (www.roinstitute.org),
a nonprofit foundation to support research and education efforts around the
world that enhance and confirm the critical role of radiation therapy in
improving cancer treatment. To learn more about ASTRO, visit www.astro.org.