Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients

Uematsu, Minoru; Shioda, Akira; Tahara, Kazuhiko; Fukui, Toshiharu; Yamamoto, Fukuju; Tsumatori, Gentaro; Ozeki, Yuichi; Aoki, Teruhiro; Watanabe, Masahiro; Kusano, Shoichi

doi:10.1002/(sici)1097-0142(19980315)82:6<1062::aid-cncr8>3.0.co;2-g

Cited by 283 publications

(133 citation statements)

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“…Pioneers of small-volume high-dose IGRT have shown that 60 Gy in 8 -10 fractions was a safe and effective dose in small-field noncoplanar irradiation of lung tumors. 11,18 We have adapted their schedule, giving 60 Gy in eight fractions to patients with tumors located in the segmental bronchus or peripheral region. Because one of our patients died of a trachiobronchial ulcer after intraoperative irradiation using a similar high dose, 16 we reduced the dose to 48 Gy (43.2 Gy at the 90% isodose line) in eight fractions for a target volume involving the lobar or more central bronchus.…”

Section: Igrtmentioning

confidence: 99%

“…10,11 However, the effectiveness and safety of irradiation stereotactic devices for extracranial tumors that are moved by respiration have not been clarified sufficiently. Stereotactic body frames, oxygen masks, and abdominal belts increase the success of small-volume high-dose irradiation.…”

mentioning

confidence: 99%

“…The use of computed tomography scans (CT) in the treatment room increases the accuracy of the set up of body tumors. 11 However, it has not been determined whether an expensive CT scanner is essential for a high control rate with small lung tumors. Small-volume high-dose IGRT has been used mainly to treat inoperable elderly patients with poor pulmonary function or unfavorable health.…”

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confidence: 99%

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Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas

Fukumoto

Shirato

Shimzu

et al. 2002

Cancer

122

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BACKGROUNDOccasionally, medically compromised and/or elderly patients with nonsmall cell lung carcinomas (NSCLCs) cannot be treated surgically. We investigated small‐volume hypofractionated image‐guided radiotherapy (IGRT) without the need for breath control in patients with inoperable Stage I NSCLCs.METHODSBetween September 1996 and September 1999, 22 patients with Stage I NSCLCs, including 19 males and 3 females, were treated with IGRT. Among these patients, there were 13 Stage IA and 9 Stage IB tumors. The tumors ranged in size from 14.2 to 58.5 mm, with a median size of 26.7 mm. Of the 22 patients, 19 were unfit for surgical treatment due to poor pulmonary function, complications, and/or advanced age and 3 refused surgery. Computed tomographic scans (CT) of the primary tumor were taken during three respiratory phases and they were analyzed to determine the planning target volume, which included only the primary tumor with allowances for respiratory movement. The radiation doses administered at the edge of the moving tumor during normal breathing were 80% of the prescribed dose, either 48 or 60 Gy given in eight fractions over 2 weeks. Clinical evaluation, chest CT scan, and pulmonary function tests were performed before irradiation and at regular intervals for the post‐IGRT follow‐up. The median follow‐up period was 24 months (range, 2–44 months; mean, 21.8 months) (at least 24 months for survivors).RESULTSOf 17 tumors assessed at the initial follow‐up 2–6 months after treatment (5 complete responses, 11 partial responses, and 1 progressive disease), 16 (94%) were controlled locally. One local recurrence was observed during the follow‐up. The lung carcinoma‐specific survival rate at 1 year was 94% and the 1‐year actuarial recurrence‐free survival rate was 71%. The lung carcinoma‐specific survival rate at 2 years was 73% and the 2‐year actuarial recurrence‐free survival rate was 67%. The treatment was well tolerated and no major side effects were observed. Localized radiation pneumonitis was observed in all patients who were examined by CT scan, but the patients were asymptomatic. Parameters of pulmonary function, including vital capacity, total lung capacity, and diffusion capacity for carbon monoxide, decreased very little or not at all, indicating that IGRT rarely deteriorated pulmonary functions.CONCLUSIONSSmall‐volume hypofractionated IGRT without breath control is a feasible and beneficial method for the curative treatment of patients with Stage I NSCLCs. It has the potential of a high local tumor control rate and low morbidity. Cancer 2002;95:1546–53. © 2002 American Cancer Society.DOI 10.1002/cncr.10853

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Section: Igrtmentioning

confidence: 99%

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Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas

Fukumoto

Shirato

Shimzu

et al. 2002

Cancer

122

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“…There is a more accurate method for eliminating the daily differences in the target center or set-up error. Uematsu et al reported the fusion of CT and linac (FOCAL) system for achieving the direct positioning of the target with a CT scanner and immediate radiotherapy using a linear accelerator [11,17]. Onishi et al also introduced a similar treatment unit to provide precise targeting of the tumor [18].…”

Section: Discussionmentioning

confidence: 99%

Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors

et al. 2006

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“…Beginning in October 1994, 45 patients with primary or metastatic lung cancers were treated using a linear accelerator with in-room CT guidance. Radiation doses were 30-75 Gy in 5-15 fractions over 1-3 weeks, with or without conventional radiation therapy [10] . Careful protocol work commenced soon thereafter in the USA and is well reported in this volume.…”

Section: Stereotaxis and Radiotherapy Deliverymentioning

confidence: 99%

New Technologies in the Radiotherapy Clinic

Meyer¹,

Verhey²,

Xia

et al. 2007

IMRT, IGRT, SBRT - Advances in the Treatment Planning and Delivery of Radiotherapy

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What are the limitations to the accuracy of our current technologies in radiation oncology? The immobilization of the patient, definition of the target, motion of the target and localization of the target are the major concerns that must be addressed. Current approaches to meet these needs have brought new technical systems with greater precision and new clinical procedures with higher expectations of practice. This text offers discussions on these issues, including advances in intensitymodulated radiotherapy planning, clinical target definition for the major tumor sites, management of organ motion, target localization and image guidance systems, and the expanding applications of high-precision treatment with stereotactic body radiotherapy. The technologies of radiotherapy planning and delivery have undergone rapid change. While these changes have been welcomed and carefully nurtured for the benefit of the cancer patient, each change has carried with it a spectrum of new concerns about its appropriate application and efficient integration into radiotherapy practice. These technologies, and the clinical treatment programs that bring them into practical use, are the focus of this volume.These technical achievements are closely interrelated: one development gives opportunity for another, but often necessitates the creation of a third, and then redefines the use of several others. Understanding this evolving world of new technologies and their applications requires broad perspectives from different vantage points. This volume first takes the viewpoint of computerized treatment planning and delivery with intensity-modulated radiotherapy (IMRT), an elaboration of

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Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients

Cited by 283 publications

References 15 publications

Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas

Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas

Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors

New Technologies in the Radiotherapy Clinic

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