Preliminary results of the STARLORD study: a mono-institutional prospective phase II experience of STereotActic Radiotherapy for LOcally advanced non small cell lung cancer ineligible for concurrent chemoRaDiation.

Abstract

AimsFor patients with unresectable stage III non-small cell lung cancer (NSCLC) ineligible for concurrent chemo-radiation (cCRT), stereotactic body radiotherapy (SBRT) may provide a favorable efficacy-toxicity balance.Materials and methodsSTARLORD (STereotActic Radiotherapy for LOcally advanced non--small cell lung cancer ineligible for concurrent chemoRaDiation) is a prospective phase II study evaluating safety and early outcomes of SBRT after chemotherapy is delivered with Radixact system.ResultsTwenty-six consecutive patients with stage IIIB-IIIC NSCLC were analyzed with median age 75.5 years (IQR, 72.2-79.8), with 84.6% of patients presenting stage IIIB disease and 15.4% stage IIIC. Following induction chemotherapy, SBRT was delivered to both the primary tumor and mediastinal disease in 5 fractions, for median total doses, respectively, of 40 Gy (IQR, 40-45 Gy) and 35 Gy (IQR, 35-40 Gy). Consolidation immunotherapy was administered in 76.9% of patients. After a median follow-up of 17.3 months, acute grade 3 (G3) dysphagia was observed in 7.7%, no late grade ≥3 toxicities were observed. The 1-year local control (LC) rate was 86.7%, with two mediastinal progressions occurring 11 and 12 months after SBRT. Median distant progression-free survival (mDPFS) was 15.6 months with a 1-year DPFS rate of 56.7%. Four deaths were recorded during follow-up, resulting in a 1-year overall survival (OS) rate of 90.9%, with worse outcomes for patients with stage IIIC disease (log-rank P = .00027) and aged ≥75 years (log-rank P = .032).ConclusionsIn our experience, for frailer patients with unresectable locally advanced NSCLC, SBRT is well tolerated and provides promising disease control outcomes.