Prospective Study of Fatigue and Quality of Life after Stereotactic Body Radiotherapy for Medically Inoperable Early-Stage Lung Cancer

To prospectively evaluate fatigue, dyspnea and quality of life (QOL) in patients (pts) undergoing stereotactic body radiotherapy (SBRT) for lung cancer. This was an institutional IRB-approved prospective study open to all medically inoperable early stage lung cancer pts undergoing SBRT, with a planned accrual of 20 pts. HADS (Hospital Anxiety and Depression Scale) screened pts pre-SBRT for factors potentiating fatigue. FACT-L (Functional Assessment of Cancer Therapy-Lung) and the UCSD Medical Center Pulmonary Rehabilitation Program Shortness-of-Breath Questionnaire (SOBQ) were used to assess fatigue, QOL and dyspnea before treatment, at 6 weeks, and every 3 months until 12 months post-SBRT. Pre- and post-treatment investigations included: spirometry, DLCO [diffusion capacity], 6-minute walk, hemoglobin, hematocrit, serum TSH, calcium, and albumin. SBRT was delivered on a Novalis/BrainLab system, with abdominal compression for motion control and Exactrac for IGRT. Pts were enrolled between 7/08-4/09. 22 pts are available for analysis. 4 pts died during the study, and one before SBRT. There were 12 males (54.5%), 3 pts (13.6%) were still smoking, 14 pts (63.6%) had Zubrod performance 1, median age was 77.5 years (range, 61-90), 87% were inoperable because of pulmonary impairment. HADS scores did not reveal pretreatment anxiety or depression. Median tumor size was 2.95 cm (range, 1-4.6). SBRT treatments were: 9 pts-60 Gy/3fractions; 10 pts-50 Gy/5 fractions; 2 pts-50 Gy/10 fractions. Analysis to 24 weeks post-SBRT is reported, given ongoing data collection. For baseline compared to 24 weeks, there were no significant (NS) differences in median vital signs and serum chemistry values. Median total FACT-L scores were 108.4 and 110.8, at baseline and week 24, respectively, with NS differences in component scores. Mean UCSD SOBQ scores dropped 12 points between 0 and 6 weeks (but NS) and were then stable. Median baseline and 24-week FEV1s, DLCOs and 6-minute walks as % predicted were 55.5 and 48; 57 and 52.5; 68.5 and 59, respectively. Post-SBRT, dyspnea scores by SOBQ dropped early but stabilized. QOL has not revealed significant fatigue or changes from baseline functionality. Pulmonary and serum chemistries were stable. Data collection is ongoing. Completed analysis will be available for the annual meeting.