CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Stage I Non-Small Cell Lung Cancer

Chen, Viola J.; Oermann, Eric K.; Vahdat, Saloomeh; Rabin, Jennifer S.; Suy, Simeng; Yu, Xinguang; Collins, Sean P.; Subramaniam, Deepa; Banovac, Filip; Anderson, Eric; Collins, Brian T.

doi:10.3389/fonc.2012.00009

Cited by 31 publications

(28 citation statements)

References 27 publications

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“…Radiotherapy has recently achieved higher levels of accuracy in covering tumors, thanks to advances in respiratory motion management (5) and various image-guidance techniques (6). The cyberknife, originally designed for use on cranial lesions, is now good enough to also be applied to cervical and body lesions (7).…”

Section: Definition and History Of Sbrtmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Stage I Non-small-cell Lung Cancer: A Historical Overview of Clinical Studies

Oda

Araki

2013

Japanese Journal of Clinical Oncology

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Because of difficulties with stabilization, breathing motion and dosimetry, stereotactic body radiotherapy for lung cancer has only been practiced for the past 15 years. However, a large amount of case data has rapidly been accumulated in recent years. Stereotactic body radiotherapy for Stage I non-small-cell lung cancer has been actively investigated in inoperable patients since around 1995, and a number of clinical trials have been undertaken. Early studies from 2001 presented a 3-year local control rate of 94% and a 3-year overall survival rate of 66% for patients receiving 50 -60 Gy in 10 fractions. Another study in 2005, using 48 Gy in four fractions, presented a 3-year local control rate of 98% and 3-year overall survival rates of 83% for Stage IA patients and 72% for Stage IB patients. A multi-institutional study showed favorable local control and survival rates in a group receiving a biologically effective dose of 100 Gy. A dose-escalation study in the USA suggested a maximum tolerated dose of 60 Gy in three fractions. A Phase II clinical trial (RTOG0236) followed, with a reported 3-year local control rate of 98% and a 3-year overall survival rate of 56% for patients who received 60 Gy in three fractions. A Japanese Phase II clinical trial (JCOG0403) investigated a dose of 48 Gy in four fractions among 165 Stage IA patients, showing a 3-year survival rate of 76% and a 3-year locally progression-free survival rate of 69% for the operable group. An overview of past clinical trials in stereotactic body radiotherapy for Stage I non-small-cell lung cancer and current issues is presented and discussed.

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Section: Definition and History Of Sbrtmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Stage I Non-small-cell Lung Cancer: A Historical Overview of Clinical Studies

Oda

Araki

2013

Japanese Journal of Clinical Oncology

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“…This technique uses gold markers placed by an interventional pulmonologist within or directly adjacent to the tumor to monitor lesion movement with respiration using periodically obtained x-rays during treatment. The non-isocentric robotic stereotactic system allows for highly conformal dose distributions with rapid dose fall off, permitting treatment margin reduction and thus minimizing delivery of excess dose to adjacent normal tissues [11, 12]. The aggregate result is a minimization of excess dose to adjacent lung parenchyma, heart, and esophagus as well as avoidance of burdensome patient immobilization devices during treatment.…”

Section: Introductionmentioning

confidence: 99%

“…The aggregate result is a minimization of excess dose to adjacent lung parenchyma, heart, and esophagus as well as avoidance of burdensome patient immobilization devices during treatment. Since 2005, our institution has treated patients with this image-guided fiducial-based SBRT technique utilizing continuous tracking of tumor motion [11, 12]. In this retrospective analysis, we investigate clinical outcomes of patients with stage I NSCLC from a single institution treated with robotically delivered fiducial-based SBRT.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of stereotactic body radiation therapy (SBRT) with fiducial tracking for inoperable stage I non-small cell lung cancer (NSCLC)

et al. 2016

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BackgroundStereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC) is considered standard of care in the medically inoperable patient population. Multiple methods of SBRT delivery exist including fiducial-based tumor tracking, which allows for smaller treatment margins and avoidance of patient immobilization devices. We explore the long-term clinical outcomes of this novel fiducial-based SBRT method.MethodsIn this single institutional retrospective review, we detail the outcomes of medically inoperable pathologically confirmed stage I NSCLC. Patients were treated with the Cyberknife SBRT system using a planning target volume (PTV) defined as a 5-mm expansion from gross tumor volume (GTV) without creation of an internal target volume (ITV). Dose was delivered in three or five equal fractions of 10 to 20 Gy. Pretreatment and posttreatment pulmonary function test (PFT) changes and evidence of late radiological rib fractures were analyzed for the majority of patients. Actuarial local control, locoregional control, distant control, and overall survival were calculated using the Kaplan-Meier method.ResultsSixty-one patients with a median age of 75 years were available for analysis. The majority (80 %) of patients were deemed to be medically inoperable due to underlying pulmonary dysfunction. Eleven patients (18 %) developed symptomatic pneumothoraces secondary to fiducial placement under CT guidance, which precipitously dropped to 0 % following transition to bronchoscopic fiducial placement. The 2-year rib fracture risk was 21.4 % with a median time to rib fracture of 2.9 years. PFTs averaged over all patients and parameters demonstrated small absolute declines, 5.7 % averaged PFT decline, at approximately 1 year of follow-up, but only the diffusing capacity of lung for carbon monoxide (DLCO) demonstrated a statistically significant decline (10.29 vs. 9.01 mL/min/mmHg, p = 0.01). Five-year local control, locoregional control, and overall survival were 87.6, 71.8, and 39.3 %, respectively.ConclusionsDespite reduced treatment margins and lack of patient immobilization, SBRT with fiducial-based tumor tracking achieves clinically comparable long-term outcomes to other linac-based SBRT approaches.

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“…In our study, CK was proven to be feasible and safe, while achieving excellent rates of local disease control with limited toxicity to surrounding tissues and, in several cases, may be curative for patients who are not candidates for surgery. In experiments performed by other research centers, CK achieved higher locoregional control and survival rates similar to wedge resection (23).…”

Section: Discussionmentioning

confidence: 72%

Advantages of CyberKnife for inoperable stage I peripheral non-small-cell lung cancer compared to three-dimensional conformal radiotherapy

Tong

Yan

Yuan

et al. 2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to compare the clinical curative effect and acute radiation lung reactions between CyberKnife (CK) and three-dimensional conformal radiotherapy (3DCRT) treatment for inoperable stage I peripheral non-small-cell lung cancer (NSCLC). We retrospectively analyzed 68 patients with inoperable stage I peripheral NSCLC between 2012 and 2013 in our institution. The CK patients were treated with 42-60 Gy in three fractions, while the 3DCRT patients were treated with a total of 60 Gy, at 2 Gy per fraction. The patients were followed up and the clinical outcome was evaluated according to the Response Evaluation Criteria in Solid Tumours. We assessed the presence of acute radiation pneumonitis and pulmonary function status by thoracic scan and pulmonary function tests following CK and 3DCRT treatment. The binary univariate logistic regression analysis demonstrated that treatment method and forced expiratory volume in 1 sec̸forced vital capacity (FEV1̸FVC) prior to treatment (pre-FEV1̸FVC) were the main factors affecting the risk of radiation pneumonitis. The analysis of these factors through multivariate logistic regression method demonstrated that treatment method for grade 1 and 2 [odds ratio (OR)=7.866 and 11.334, respectively) and pre-FEV1/FVC for grade 1, 2 and 3 (OR=5.062, 11.498 and 15.042, respectively) were significant factors affecting the risk of radiation pneumonitis (P<0.05). The 68 patients were divided into two subgroups using the threshold of pre-FEV1/FVC selected by the receiver operating characteristic curve. There were significant differences between the 3DCRT and CK treatment in both the pre-FEV1̸FVC <68% and ≥68% subgroups for radiation pneumonitis (P=0.023 and 0.002, respectively). There was no statistically significant change in FVC, FEV1 and carbon monoxide diffusion capacity (DCLO) in the CK group, whereas there was a decrease in DCLO in the 3DCRT group. The complete remission rate was 40 vs. 34.2% at 1 year in the CK and 3DCRT groups, respectively. In conclusion, in this cohort of patients with inoperable stage I peripheral NSCLC, CK appears to be a safe and superior alternative to conventionally fractionated radiotherapy.

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CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Stage I Non-Small Cell Lung Cancer

Cited by 31 publications

References 27 publications

Stereotactic Body Radiation Therapy for Stage I Non-small-cell Lung Cancer: A Historical Overview of Clinical Studies

Stereotactic Body Radiation Therapy for Stage I Non-small-cell Lung Cancer: A Historical Overview of Clinical Studies

Long-term outcomes of stereotactic body radiation therapy (SBRT) with fiducial tracking for inoperable stage I non-small cell lung cancer (NSCLC)

Advantages of CyberKnife for inoperable stage I peripheral non-small-cell lung cancer compared to three-dimensional conformal radiotherapy

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