Stereotactic body radiation therapy for stage I small cell lung cancer: a single institutional case series and review of the literature

Objective Stage I small cell lung cancer (SCLC) is rare, and current treatment approach supports surgical resection with adjuvant platinum chemotherapy. Stereotactic body radiation therapy (SBRT) is an excellent alternative to surgery in inoperable non-small cell lung cancer, but its role in the management of stage I SCLC is not well-defined. Methods Eight patients with stage I SCLC who received SBRT due to surgical contraindications and three patients who received SBRT as salvage for recurrent stage I SCLC originally treated with fractionated radiation and chemotherapy were identified. Patients were treated with 50 Gy in four fractions. Adjuvant chemotherapy was given as the discretion of the treating oncologists. Data was analyzed using KaplanMeier survival estimates. Results Five of the eight primary patients were treated with SBRT and adjuvant chemotherapy. The local recurrence-free survival, recurrence-free survival, and overall survival were 100, 50, and 88 % for all eight patients at 1 year. Overall survival and recurrence-free survival of all primary treated patients at 3 years was 37 and 38 %. However, patients who received chemotherapy after SBRT gave a 3-year overall and recurrence-free survival of 60 and 60 %. The three patients who received SBRT salvage therapy for recurrent stage I SCLC had mixed results. Results from two similar studies that evaluated the use of SBRT for stage I SCLC were reviewed. Conclusion SBRT is a reasonable approach for stage I SCLC patients who are unfit for surgery followed by adjuvant platinum-based chemotherapy +/-prophylactic cranial irradiation.