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Open Access Research

Stereotactic body radiation therapy for the treatment of early-stage minimally invasive adenocarcinoma or adenocarcnioma in situ (formerly bronchioloalveolar carcinoma): a patterns of failure analysis

Shahed N Badiyan1, Andrew J Bierhals2, Jeffrey R Olsen1, Kimberly M Creach1, Adam A Garsa1, Todd DeWees1, Jeffrey D Bradley1 and Clifford G Robinson1*

Author Affiliations

1 Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA

2 Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA

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Radiation Oncology 2013, 8:4  doi:10.1186/1748-717X-8-4

Published: 3 January 2013

Abstract

Introduction

Ongoing prospective trials exploring stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) often exclude minimally invasive adenocarcinoma or adenocarcnioma in situ, formerly bronchioloalveolar carcinoma (BAC), due to concerns for accurate target delineation on CT. We performed a patterns of failure analysis to compare outcomes between BAC and other NSCLC subtypes.

Methods

One hundred twenty patients with early stage NSCLC were treated with SBRT from 2004–2009. Pathologic confirmation of NSCLC was obtained in 97 patients. Radiotherapy was delivered according to RTOG guidelines. The log-rank test was used to compare outcomes between BAC and other NSCLC.

Results

Median follow-up was 29 months. The median SBRT dose was 5400 cGy. Thirteen patients had radiographically diagnosed BAC and five patients had biopsy confirmed BAC, of which two had both. The three-year local control was 100% for biopsy-proven or radiographically diagnosed BAC (n = 18) and 86% for all other NSCLC subtypes (n = 102) (p = 0.13). Likewise, no significant difference was detected between BAC and other NSCLC for 3-year regional failure (12% vs. 20%, p = 0.45), progression-free survival (57.6% vs. 53.5%, p = 0.84) or overall survival (35% vs. 47%, p = 0.66). There was a trend towards lower three-year rates of freedom from distant failure in patients with any diagnosis of BAC compared to those without (26% vs. 38%, p = 0.053).

Conclusions

Compared to other NSCLC subtypes, BAC appears to have similar patterns of failure and survival after treatment with SBRT, however there may be an increased risk of distant metastases with BAC. RTOG guideline-based target delineation provides encouraging local control rates for patients with BAC.

Keywords:
SBRT; Bronchioloalveolar carcinoma; Adenocarcinoma in situ; Minimally invasive adenocarcinoma; BAC; SABR