Stereotactic Body Radiotherapy for Primary Lung Cancer at a Dose of 50 Gy Total in Five Fractions to the Periphery of the Planning Target Volume Calculated Using a Superposition Algorithm

Takeda, Atsuya; Sanuki, Naoko; Kunieda, Etsuo; Ohashi, Toshio; Oku, Yohei; Takeda, Toshiaki; Shigematsu, Naoyuki; Kubo, Atsushi

doi:10.1016/j.ijrobp.2008.04.043

Cited by 102 publications

(62 citation statements)

References 34 publications

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“…SBRT for treating lung cancer results in high local control rates and allows for a painless ambulatory treatment with minimal toxicity by focusing high radiation doses onto the target and by sparing the surrounding normal tissue [12][13][14][15]. SBRT is indicated for small lung tumours, i.e.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Takeda

Ohashi²,

Kunieda

et al. 2012

BJR

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Objective: The aim of this study was to investigate significant clinical, tumour-related and dosimetric factors among patients with grade 0-1, grade 2 and grade 3 radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for lung tumours. Methods: Patients (n5128) with a total of 133 lung tumours treated with SBRT of 50 Gy in 5 fractions were analysed. RP was graded according to the Common Terminology Criteria for Adverse Events v.3.0. Significant factors were identified by univariate and multivariate analyses. Threshold dose-volume histograms (DVHs) were constructed to identify the incidence of RP. Results: The median follow-up period was 12 months (range, 6-45 months). In univariate analyses, gender, operability, forced expiratory volume in 1 s (FEV1), internal target volume, lung volumes treated with doses .5-30 Gy (V5-30) and mean lung dose were significant factors differentiating between grade 0-1 and grade 2 RP, and V15-30 were significant factors differentiating between grade 2 and grade 3. However, no factors were significant between grade 0-1 and grade 3 RP. Multivariate analysis showed that female gender, high FEV1 and high V15 were significant factors differentiating between grade 0-1 and grade 2 RP. Threshold DVH curves were created based on #5% and #15% risk of grade 2 RP among patients with grade 0-2 RP. Conclusions: Grade 0-2 RP was dose-volume dependent, and female gender and high FEV1 were significant predictive clinical factors for grade 2 RP among patients with grade 0-2 RP. However, incidences of V15-30 in grade 3 RP were significantly lower than those in grade 2 RP, and no significant clinical or tumour-related factors were found. Further studies are needed to identify the mechanism underlying the development of grade 3 RP after SBRT for lung tumours. Previously, we investigated the clinical and dosimetric factors that correlate with severe radiation pneumonitis (RP) in patients with lung tumours treated with stereotactic body radiotherapy (SBRT) [1]. We found that, among a variety of factors, only a short latent period was a significant correlate of severe RP.Other reports [2][3][4][5][6] have also analysed the clinical and dosimetric factors correlated with RP after SBRT. Various dosimetric factors were reported to significantly correlate with RP after SBRT, which included the mean dose in the ipsilateral lung, V7 and V10 by Kyas et al [2], normal tissue complication probability (NTCP) by Ricardi et al [3], lung volumes treated with doses higher than 2.5-50 Gy (V2.5-50) by Guckenberger et al [4], mean lung dose by Barriger et al [5] and contralateral V5 by Ong et al [6].We found a discrepancy in the significant clinical and dosimetric factors between the results of these five studies on low-grade RP [2-6] and our study on severe RP [1]. We speculated that the mechanism underlying the development of grade $3 RP might be different from that of grade 2 RP. Additionally, the treatment of grade $3 RP was much more critical than that of grade 2 RP. Most patients with grade $3 RP nee...

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Takeda

Ohashi²,

Kunieda

et al. 2012

BJR

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“…SBRT fractionation regimens for lung tumors range from one single fraction 158 to 3 fractions, 149,150 4 fractions, 159 and 5 fractions 160,161 (see Table 4 on page 763). Although the optimal number of fractions may be estimated based on the tumor size and total dose, 162 an accumulated biologic equivalent dose (BED) of 100 Gy or more is associated with better survival.…”

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confidence: 99%

Non–Small Cell Lung Cancer

Ettinger

Akerley

Bepler

et al. 2010

J Natl Compr Canc Netw

603

371

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“…In recent years, the use of x-ray stereotactic radiotherapy has been spreading worldwide as a new treatment modality for stage I NSCLC. [2][3][4][5] High local control rates and 5-year survival rates of around 70% have been reported. 2,3 Some studies reported that dose escalation to the target volume improved the probability of local control and overall survival.…”

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confidence: 99%

High‐dose proton therapy and carbon‐ion therapy for stage I nonsmall cell lung cancer

Iwata

Murakami

Demizu

et al. 2010

Cancer

100

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patients with stage I NSCLC were treated with proton therapy or carbon-ion therapy (57 with proton therapy and 23 with carbon-ion therapy) using 3 treatment protocols. In the first protocol, 80 gray equivalents (GyE) of proton therapy was given in 20 fractions, and the second proton therapy protocol used 60 GyE in 10 fractions. For carbon-ion therapy, 52.8 GyE was given in 4 fractions. After achieving promising preliminary results for the first protocol, the authors started to use the second proton therapy protocol to shorten the overall treatment time. Carbon-ion therapy was started in 2005, and thereafter, both proton and carbon-ion therapy plans were made for each patient, and the 1 that appeared superior was adopted. Patient age ranged from 48 to 89 years (median, 76 years). Thirty-seven patients were medically inoperable, and 43 refused surgery. Forty-two patients had T1 tumors, and 38 had T2 tumors. RESULTS: The median follow-up period for living patients was 35.5 months. For all 80 patients, the 3-year overall survival, cause-specific survival, and local control rates were 75% (IA: 74%; IB: 76%), 86% (IA: 84%; IB: 88%), and 82% (IA: 87%; IB: 77%), respectively. There were no significant differences in treatment results among the 3 protocols. Grade 3 pulmonary toxicity was observed in only 1 patient. CONCLUSIONS: Proton therapy and carbon-ion therapy are safe and effective for stage I NSCLC. Further investigation of particle therapy for stage I NSCLC is warranted. Cancer 2010;116:2476-85.

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Stereotactic Body Radiotherapy for Primary Lung Cancer at a Dose of 50 Gy Total in Five Fractions to the Periphery of the Planning Target Volume Calculated Using a Superposition Algorithm

Cited by 102 publications

References 34 publications

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Comparison of clinical, tumour-related and dosimetric factors in grade 0–1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours

Non–Small Cell Lung Cancer

High‐dose proton therapy and carbon‐ion therapy for stage I nonsmall cell lung cancer

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