Stereotactic Body Radiotherapy for Medically Inoperable Lung Cancer: Prospective, Single-Center Study of 108 Consecutive Patients

Taremi, Mojgan; Hope, Andrew; Dahele, Max; Pearson, Shannon; Fung, Sharon; Purdie, Thomas G.; Brade, Anthony; Cho, John; Sun, Alexander; Bissonnette, Jean‐Pierre; Bezjak, Andrea

doi:10.1016/j.ijrobp.2010.12.039

Cited by 155 publications

(105 citation statements)

References 26 publications

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“…Given that comorbidities associated with tobacco consumption frequently limit patients' eligibility for surgery, 1 stereotactic body radiotherapy (SBRT) has become an alternative treatment in primary-and more recently also in second-primaryearly stage (Ia-Ib) medically inoperable lung neoplasm (SPLN). Several prospective studies using SBRT to treat patients with primary Stage I NSCLN unfit for surgical resection found good local control rates (LCRs) at 1 year (92% 2 ) and 2 years (70% 3 ), with overall survival (OS) of 84% 2 and 65%, 3 respectively. On the other hand, reports on the use of SBRT in operable cases are limited.…”

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confidence: 99%

Stereotactic body radiotherapy with helical TomoTherapy for medically inoperable early stage primary and second-primary non-small-cell lung neoplasm: 1-year outcome and toxicity analysis

Casutt

Bouchaab²,

Bourhis³

et al. 2015

BJR

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The authors Alban Lovis and Oscar Matzinger contributed equally to this article.Objective: This study investigated the effectiveness of stereotactic body radiotherapy with helical TomoTherapy (T-SBRT) for treating medically inoperable primary and second-primary early stage non-small-cell lung neoplasm (SPLN) and evaluated whether the movement of organizing pneumonia (OP) within the irradiation field (IF) can be detected via analysis of radiological changes. Methods: Patients (n 5 16) treated for 1 year (2011-12) at our hospital by T-SBRT at a total dose of 60 Gy in five fractions were examined retrospectively. Outcome and toxicity were recorded and were separately described for SPLN. CT scans were reviewed by a single radiologist. Results: Of the 16 patients, 5 (31.3%) had primary lung malignancies, 10 (62.5%) had SPLN, and 1 case (6.3%) had isolated mediastinal metastasis of lung neoplasm. Pathological evidence was obtained for 72.2% of all lesions. The median radiological follow-up was 11 months (10.5 months for SPLN). For all cases, the 6-and 12-month survival rates were 100% and 77.7% (100% and 71.4%, respectively, for SPLN), and the 6-and 12-month locoregional control rates were 100% in all cases. 2 (12.5%) of 16 patients developed grade 3 late transient radiation pneumonitis following steroid therapy and 1 (6.3%) presented asymptomatic infiltrates comparable to OP opacities. Conclusion: T-SBRT seems to be safe and effective. Advances in knowledge: Mild OP is likely associated with radiation-induced anomalies in the IF, identification of migrating opacities can help discern relapse of radiationinduced opacities.

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confidence: 99%

Stereotactic body radiotherapy with helical TomoTherapy for medically inoperable early stage primary and second-primary non-small-cell lung neoplasm: 1-year outcome and toxicity analysis

Casutt

Bouchaab²,

Bourhis³

et al. 2015

BJR

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“…In the study by Fakiris et al, grades 3-5 toxicity occurred in 27% of patients with central lesions, compared to 10% of patients with peripheral tumors treated with a dose of 60-66 Gy in three fractions [15]. However, acceptable levels of early pulmonary toxicity have been reported for central lung lesions treated with less aggressive fractionation schemes such as 50-60 Gy in eight to ten fractions [16], 50 Gy in five fractions [17], 48 Gy in four fractions [18] and 60 Gy in eight fractions [19]. In all these studies, lung lesions are categorized as central or peripheral based solely on the nearest distance from the main bronchial tree.…”

Section: Discussionmentioning

confidence: 99%

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

et al. 2012

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Purpose: Stereotactic body radiation therapy is an emerging technique in the treatment of peripheral lung tumors. However, due to early reports of increased toxicity, the treatment of central lung lesions with hypo-fractionated high-dose regimen remains controversial. Thus far, lung lesions have been defined as either central or peripheral depending solely on their nearest distance from the major airways. The goal of this study is to develop a quantitative method to categorize the location of lung lesions mapped in three-dimensional space. Furthermore, a set of parameters are proposed for assessing risk factors based on target locations. Methods and Materials: A MATLAB program was developed to quantify the distance between the tumor and the airways, and to calculate the percentage of the target volume lying within a given distance from the main bronchial tree. The program was tested on 20 patients with centrally located lung lesions treated with CyberKnife. A dosimetric analysis was performed to investigate the relationship between dose delivered to the critical structures and target location. Results: The absolute target volume located within a distance of 20 mm from the airways was used to quantify the tumor proximity to the bronchial tree. A strong correlation was found between this parameter and the dose delivered to the critical organs, showing that a detailed knowledge of target location can be used to assess the risk of toxicity during the planning stage. Conclusions: We have developed a tool to quantify the lesion proximity to the bronchial tree. We expect that riskadapted strategies, accounting for the exact geometric relationship between the tumor and the airways, may improve the management of centrally located lung lesions.

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“…Stereotactic body radiotherapy (SBRT) offers a genuine alternative to surgery for patients with early stage non‐small cell lung cancer (NSCLC) who cannot tolerate surgery due to coexisting illnesses (i.e., coronary heart disease, insufficiency pulmonary function), or who refuse to take surgery 1 , 2 , 3 . It is reported that local control rates can reach

85 normal% - 90 normal%

after SBRT for early stage lung cancer, which is almost equal to surgery alone 1 , 2 .…”

Section: Introductionmentioning

confidence: 99%

“…It is reported that local control rates can reach

85 normal% - 90 normal%

after SBRT for early stage lung cancer, which is almost equal to surgery alone 1 , 2 . Up to now, the clinical application of SBRT has been extended to oligometastatic lung tumors and other types of malignancies, such as liver cancer and pancreatic cancer 4 , 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone‐beam computed tomography

Sun

Cheng

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to determine interfractional variation of the centroid position and volume of internal target volume (ITV) during stereotactic body radiation therapy (SBRT) of lung cancer. From January 2014 to August 2014, a total of 32 patients with 37 primary or metastatic lung tumors were enrolled in our study. All patients received SBRT treatment in 4–5 fractions to a median dose of 48 Gy. Both 3D CT and 4D CT scans were used for radiotherapy treatment planning. 3D CBCT was acquired prior to treatment delivery to verify patient positioning. A total of 163 3D CBCT images were available for evaluation. 3D CBCT scans acquired for verification were registered with simulation CT scans. The ITVs were contoured on all verification 3D CBCT scans and compared to the initial gross target volume (GTV) or ITV in treatment planning system. GTV was based on 3D CT while ITV was based on both 3D CT and 4D CT. To assess the interfractional variation of ITV centroid position, we used vertebrae body adjacent to the tumor as reference point when performing the registration procedure. To eliminate the effect of time on tumor volume between simulation CT scan and the first fraction, the interfractional variation of ITV was evaluated from the first fraction to the last fraction. The overall 3D vector shift was 4.4±2.5 mm (range: 0.4−13.8 mm). The interfractional variation of ITV centroid position in superior‐inferior, anterior‐posterior, and left‐right directions were −0.7±2.7 mm, −1.4±3.4 mm, and −0.5±2.2 mm, respectively. No significant difference was observed between three directions (p=0.147). Large interfractional variations (≥5 mm) were observed in 12 fractions (9.3%) in superior‐inferior direction, 24 fractions (18.6%) in anterior‐posterior direction, and 5 fractions (3.9%) in left‐right direction. No time trend of tumor volume change measured in 3D CBCT was detected during four fractions (p=0.074). A significant (p=0.010) time trend was detected when evaluating the time trend of ITV change during 5 fractions and diameter was found to be significantly correlated with the ITV change (p=0.000). ITV did not show significant regression during SBRT treatment, but interfractional variation in the ITV centroid position was observed, especially in anterior‐posterior direction. An isotropic margin of 7 mm around ITV might be necessary for adequate coverage of interfractional variation of ITV centroid position, but only in case no soft tissue‐based setup is performed during SBRT treatment.PACS number(s): 87.55.dk

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Stereotactic Body Radiotherapy for Medically Inoperable Lung Cancer: Prospective, Single-Center Study of 108 Consecutive Patients

Cited by 155 publications

References 26 publications

Stereotactic body radiotherapy with helical TomoTherapy for medically inoperable early stage primary and second-primary non-small-cell lung neoplasm: 1-year outcome and toxicity analysis

Stereotactic body radiotherapy with helical TomoTherapy for medically inoperable early stage primary and second-primary non-small-cell lung neoplasm: 1-year outcome and toxicity analysis

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone‐beam computed tomography

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