Stereotactic Body Radiation Therapy Plus Chemotherapy Improves Survival Among Patients With Stage IV Lung Cancer


Key Points

  • Median progression-free survival was 14.7 months, and median overall survival was 20.4 months.
  • Most patients progressed in new distant sites, with only 3 of 47 measurable lesions recurring within the SBRT field.

A clinical trial that combined stereotactic body radiation therapy (SBRT) with erlotinib chemotherapy more than doubled survival rates for certain patients with stage IV lung cancer patients, reported Iyengar et al in the Journal of Clinical Oncology.

SBRT is a type of radiation therapy in which a few very high doses of radiation are delivered from multiple angles to small, well-defined tumors. The goal is to deliver a radiation dose high enough to kill the cancer, while minimizing exposure to surrounding healthy tissue and organs, explained senior author Robert Timmerman, MD, Director of the Annette Simmons Stereotactic Treatment Center and Vice Chairman of Radiation Oncology at UT Southwestern Medical Center. The technique has been shown to offer better cure rates in certain instances, particularly for cancers that have metastasized, he said.

“Technologies have developed in the last few years that have yielded game-changing, paradigm-shifting approaches, allowing us to reconsider how radiation is delivered in combination with surgery, chemotherapy, and other systemic therapies,” Dr. Timmerman said.

Study Details

This single-arm phase II clinical trial involved 24 patients with stage IV non–small cell lung cancer whose cancer has continued to spread during their initial therapy. Such patients typically have poor survival rates, and SBRT is not typically used in these patients, said first author Puneeth Iyengar, MD, PhD, Assistant Professor and Director of Clinical Research of Radiation Oncology and coleader of the Simmons Cancer Center Thoracic Oncology Group.

The combination of erlotinib with SBRT resulted in a median overall survival of 20.4 months compared to the historic 6- to 9-month overall survival among patients who received erlotinib only. The combination also resulted in an improvement in progression-free survival (14.7 months vs the historic 2 to 4 months for similarly selected lung cancer patients). The majority of patients progressed in new distant sites, with only 3 of 47 measurable lesions occurring within the SBRT field.

“Our approach dramatically changed the pattern of relapse. We saw a shift in failure from existing, local sites to new, distant sites,” said Dr. Timmerman. “This shift resulted in a surprisingly long remission from the reappearance of cancer in treated patients.”

According to the National Cancer Institute, lung cancer will be diagnosed in an estimated 224,210 men and women during 2014. Five-year relative survival rates remain low at just 16.8% from 2004 to 2010. Of these cancer cases, about 85% were categorized as non–small cell lung cancer.

The trial was supported by OSI Pharmaceuticals. For full disclosures of the study authors, visit

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