Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy

Abstract

BackgroundTo retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy.MethodsBetween April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy), and the median total dose was 49.5 Gy (range, 45–72 Gy). The median estimated biological effective dose at 10 Gy (BED10) was 71.8 Gy (range, 65.3–119.0 Gy), and that at 3 Gy (BED3) was 123.8 Gy (range, 112.5–233.3 Gy). The mean lung dose (MLD) was constrained mainly under 1200 cGy. The median gross tumor volume (GTV) was 27.9 cm3 (range: 2.5–178.1 cm3).ResultsThe median follow-up period was 25.8 months (range, 3.0–60.7 months). The median overall survival (OS) time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD) was 11.2 months versus >50 months (not reached) in the patients without EPD (p < 0.001). Those patients with smaller GTV (≦27.9 cm3) had a better survival than those with larger GTV (>27.9 cm3): >40 months versus 12.85 months (p = 0.047). The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065). The 2-year local control (LC) rate was 94.7%. Only 2 patients (6.1%) developed ≧grade 3 radiation pneumonitis.ConclusionUsing Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with EPD. Moreover, GTV is more significant than lesion number in predicting survival.

Current Progress in Gene Delivery Technology Based on Chemical Methods and Nano-carriers

“…Despite increasing understanding of the molecular mechanism of cancers 2, 3, many malignancies remain resistant to established traditional treatments 4, 5. However, the definition of tumor-associated genetic mutations has heightened interest in cancer treatment as the target for gene therapy 6, 7.…”

Successful radiotherapy for repeated recurrent uterine clear cell adenocarcinoma

“…According to a report on radiotherapy for patients with oligometastatic lung cancer, the median survival in those with two or fewer metastatic foci was 40 months or more, whereas that in those with three or more metastatic foci was 26 months. 7 In the present case, there were five metastatic foci (vagina: one, lungs: four). Considering this, close follow-up may be necessary in the future, although there has been no relapse during the 36-month follow-up.…”

Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases

“…In non–small‐cell lung cancer (NSCLC) or CRC oligometastases, SBRT is well tolerated and provides favorable local control (LC) and OS . Some studies have showed hypofractionated stereotactic radiotherapy delivered with less than five fractions can significantly improve outcomes . The efficacy of irradiation therapy is dose‐dependent, with higher doses tending to provide better responses .…”

“…13,16 Some studies have showed hypofractionated stereotactic radiotherapy delivered with less than five fractions can significantly improve outcomes. 17,18 The efficacy of irradiation therapy is dose-dependent, with higher doses tending to provide better responses. [19][20][21] The aim of this study was to review the outcomes of CRC oligometastases treated with hypofractionated stereotactic radiotherapy at our institution and determine the effect of BED on outcomes.…”