CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Single Peripheral Lung Metastases

Abstract

Standard treatment for operable patients with single peripheral lung metastases is metastasectomy. We report mature CyberKnife outcomes for high-risk surgical patients with biopsy proven single peripheral lung metastases. Twenty-four patients (median age 73 years) with a mean maximum tumor diameter of 2.5 cm (range, 0.8–4.5 cm) were treated over a 6-year period extending from September 2004 to September 2010 and followed for a minimum of 1 year or until death. A mean dose of 52 Gy (range, 45–60 Gy) was delivered to the prescription isodose line in three fractions over a 3–11 day period (mean, 7 days). At a median follow-up of 20 months, the 2-year Kaplan–Meier local control and overall survival rates were 87 and 50%, respectively. CyberKnife with fiducial tracking is an effective treatment for high-risk surgical patients with single small peripheral lung metastases. Trials comparing CyberKnife with metastasectomy for operable patients are necessary to confirm equivalence.

Feasibility of real‐time lung tumor motion monitoring using intrafractional ultrasound and kV cone beam projection images

“…[16][17][18][19] Implanting fiducials is invasive and can cause pneumothorax. 20 CyberKnife with fiducial tracking was proven to be an effective method for lung tumor treatment, 14 but the correlation between the fiducials and tumor should be updated periodically using x rays during treatment. 20 Several studies attempted to use external surrogates to track lung tumor motion.…”

The impact of technology on the changing practice of lung SBRT

“…The correlation model is constructed prior to each treatment fraction and verified and adapted during each treatment fraction. Fiducials can be used for target localisation, and Cyberknife treatment using fiducial tracking has been found to give comparable results for 3 year local control (91%) as for surgical resection [92] . A fiducial-less tracking system (Xsight lung tracking) is also available, and measurements on patient specific lung phantoms indicate this tracking accuracy (with mean error 0.38 ± 0.54 mm craniocaudal) is comparable to tracking using fiducials [93] .…”

Stereotaktische Strahlentherapie mit dem Cyberknife

“…Zu den klassischen Indikationen für die einzeitige radiochirurgische Behandlung zählen: Die stereotaktische hypofraktionierte Bestrahlung wird mit gutem Erfolg auch für zentrale Bronchialkarzinome (< 7 cm) ohne Lymphknotenmetastasen mit einer höheren Anzahl von Fraktionen (8 × 7,5 Gy) eingesetzt. Auch Lungenmetastasen (maximal 3 Metastasen < 3-4 cm) können gut behandelt werden [15].…”