{Reference Type}: Journal Article
{Title}: Real-World Acute Toxicity and 90-Day Mortality in Patients With Stage I NSCLC Treated With Stereotactic Body Radiotherapy.
{Author}: van Rossum PSN;Wolfhagen N;van Bockel LW;Coremans IEM;van Es CA;van der Geest AM;De Jaeger KEA;Wachters B;Knol HP;Koppe FLA;Pomp J;Reymen BJT;Schinagl DAX;Spoelstra FOB;Tissing-Tan CJA;Peters M;van der Voort van Zijp NCMG;van der Wel AM;Wiegman EM;Wijsman R;Damhuis RAM;Belderbos JSA;
{Journal}: J Thorac Oncol
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 25
{Factor}: 20.121
{DOI}: 10.1016/j.jtho.2024.07.016
{Abstract}: <B>BACKGROUND: </B>Stereotactic body radiotherapy (SBRT) has firmly established its role in stage I NSCLC. Clinical trial results may not fully apply to real-world scenarios. This study aimed to uncover the real-world incidence of acute toxicity and 90-day mortality in patients with SBRT-treated stage I NSCLC and develop prediction models for these outcomes.<BR><B>METHODS: </B>Prospective data from the Dutch Lung Cancer Audit for Radiotherapy (DLCA-R) were collected nationally. Patients with stage I NSCLC (cT1-2aN0M0) treated with SBRT in 2017 to 2021 were included. Acute toxicity was assessed, defined as grade greater than or equal to 2 radiation pneumonitis or grade greater than or equal to 3 non-hematologic toxicity less than or equal to 90 days after SBRT. Prediction models for acute toxicity and 90-day mortality were developed and internally validated.<BR><B>RESULTS: </B>Among 7279 patients, the mean age was 72.5 years, with 21.6% being above 80 years. Most were male (50.7%), had WHO scores 0 to 1 (73.3%), and had cT1a-b tumors (64.6%), predominantly in the upper lobes (65.2%). Acute toxicity was observed in 280 (3.8%) of patients and 90-day mortality in 122 (1.7%). Predictors for acute toxicity included WHO greater than or equal to 2, lower forced expiratory volume in 1 second and diffusion capacity for carbon monoxide, no pathology confirmation, middle or lower lobe tumor location, cT1c-cT2a stage, and higher mean lung dose (c-statistic 0.68). Male sex, WHO greater than or equal to 2, and acute toxicity predicted higher 90-day mortality (c-statistic 0.73).<BR><B>CONCLUSIONS: </B>This nationwide study revealed a low rate of acute toxicity and an acceptable 90-day mortality rate in patients with SBRT-treated stage I NSCLC. Notably, advanced age did not increase acute toxicity or mortality risk. Our predictive models, with satisfactory performance, offer valuable tools for identifying high-risk patients.