Prospective trial of stereotactic radiation therapy in patients with early non-small cell lung cancer and interstitial lung disease

Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. A prospective nonrandomized clinical trial at five centers in Canada and one center in Scotland assessed the benefits and toxic effects of SABR in this patient population. The trial enrolled 39 adult patients with fibrotic ILD and T1-2N0 NSCLC who received SABR to a dose of 50 Gy in 5 fractions. Median overall survival was 25 months, significantly exceeding the prespecified goal of 12 months. The risk of treatment-related mortality was 7.7%, also meeting the prespecified acceptablity threshold of less than 15%. The authors conclude that these results support the use of SABR for curative-intent treatment after a careful discussion of risks and benefits.