Toxic risk of stereotactic body radiotherapy and concurrent helical tomotherapy followed by erlotinib for non-small-cell lung cancer treatment - case report

Abstract

BackgroundStereotactic body radiation therapy (SBRT) applied by helical tomotherapy (HT) is feasible for lung cancer in clinical. Using SBRT concurrently with erlotinib for non-small cell lung cancer (NSCLC) is not reported previously.Case PresentationA 77-year-old man with stage III NSCLC, received erlotinib 150 mg/day, combined with image-guided SBRT via HT. A total tumor dose of 54 Gy/9 fractions was delivered to the tumor bed. The tumor responded dramatically and the combined regimen was well tolerated. After concurrent erlotinib-SBRT, erlotinib was continued as maintenance therapy. The patient developed dyspnea three months after the combined therapy and radiation pneumonitis with interstitial lung disease was suspected.ConclusionsCombination SBRT, HT, and erlotinib therapy provided effective anti-tumor results. Nonetheless, the potential risks of enhanced adverse effects between radiation and erlotinib should be monitored closely, especially when SBRT is part of the regimen.

Dosimetric comparison of the helical tomotherapy, volumetric-modulated arc therapy and fixed-field intensity-modulated radiotherapy for stage IIB-IIIB non-small cell lung cancer

“…VMAT has been reported to create better dose conformity or sparing of OARs with a shorter treatment time than IMRT in treating different cancers 10 – 15 . Theoretically, the VMAT technique may also produce a large volume of low dose regions in the surrounding normal tissue.…”

“…At the same time, TOMO and VMAT may deliver more extensive low-dose irradiation to the surrounding normal lung tissue. This may potentially be harmful, especially in combination with chemotherapy or target therapy 15 – 17 .…”

Fatal interstitial lung disease associated with high erlotinib and metabolite levels. A case report and a review of the literature

“…A total of 19 cases of erlotinib-associated ILD were found [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Clinical and radiologic findings including accompanying disease and outcome of the patients have been summarized in Table 1 .…”

Malignant thrombosis of the superior vena cava caused by non-small-cell lung cancer treated with radiation and erlotinib: a case with complete and prolonged response over 3 years

“…Erlotinib has been used to treat NSCLC patients with SVC syndrome in the past,7,8 and the tumors in these cases completely responded to the erlotinib. In one of these cases,7 erlotinib was used concurrently with stereotactic body radiation therapy.…”

“…In one of these cases,7 erlotinib was used concurrently with stereotactic body radiation therapy. However, regardless of the therapeutic effect, the patient developed radiation pneumonitis 3 months after treatment, with suspected interstitial lung disease.…”