Transforming lung cancer care for the underserved: Real-world results of SBRT in a safety-net system.

Abstract

e20082 Background: Stereotactic body radiotherapy (SBRT) is an established treatment for early-stage lung cancer, particularly in patients who are medically inoperable or decline surgery. Access to SBRT historically has been challenging for patients with lower socioeconomic status. This study evaluates the demographics, clinical characteristics, and outcomes of lung cancer patients who received SBRT in a safety-net hospital system. Methods: Clinical data were abstracted from all patients with primary lung malignancies who received SBRT from 2014 to 2022 at a single institution. Demographics, medical and social histories, histology, stage, radiation treatment details, ECOG (Eastern Cooperative Oncology Group) performance status at diagnosis and one year after SBRT, local or locoregional failure, development of metastases, date of last contact and cause of death were obtained from the electronic medical record. Nodule size was recorded at time of treatment. Follow-up was calculated from the date of diagnosis based on imaging to the date of last contact. Freedom from local and locoregional progression (FFLP/FFLRP), progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Progression was defined as LP, LRP, distant metastasis, or death. Statistical analyses were conducted using JMP. Results: A total of 106 patients (56% female; median age 64, range: 49-90) received SBRT with an overall median follow-up of 38 months (range: 5-139). Patients were 56% Black, 24% White, 14% Hispanic, and 6% Asian. Most patients (42%) had Medicare, 33% were uninsured and treated on a county-based financial assistance plan, 11% had exchange-based insurance, 8% had employer-sponsored insurance and 6% had Medicaid. Median smoking history was 30 pack years (range: 0-135) with 38% actively smoking and 51% with COPD. Almost a third (28%) of patients began treatment with an ECOG of 2 or greater and 30% of patients were treated without histologic confirmation. Of those with histological confirmation, 65% were adenocarcinoma and 26% squamous cell carcinoma. The median dose and fractionation were 5000 cGy (range: 4000-6000) over 4 fractions (range: 3-15). No grade 3 adverse events or hospitalizations related to SBRT were reported. One year following treatment, 41% of patients maintained their performance status and a post-treatment ECOG of 2 or greater was observed in 15% of patients who began treatment with a score of 0-1. Actuarial three-year FFLP, FFLRP, PFS and OS were 97%, 82%, 63%, and 77%, respectively. Of the 4 patients who experienced local failure, 1 had a prior history of lung cancer and 2 received a biologically effective dose (BED 10 ) of <105Gy. Conclusions: Our real-world experience underscores the practicality, safety and effectiveness of SBRT as a valuable first-line treatment option for early-stage lung cancer in resource-limited settings.