Intensity-modulated stereotactic body radiotherapy for stage I non-small cell lung cancer

Kim,Min-Jeong; Yeo,Seung-Gu; Kim,Eun   Seok; Min,Chul   Kee; An,Pyung  Se

doi:10.3892/ol.2012.1082

Intensity-modulated stereotactic body radiotherapy for stage I non-small cell lung cancer

Authors:
- Min-Jeong Kim
- Seung-Gu Yeo
- Eun Seok Kim
- Chul Kee Min
- Pyung Se An
View Affiliations

Affiliations: Department of Radiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea, Department of Radiation Oncolocy, Soonchunhyang University Hospital, Cheonan, Republic of Korea, Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
Published online on: December 18, 2012 https://doi.org/10.3892/ol.2012.1082
Pages: 840-844

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

This study aimed to investigate the clinical outcomes of intensity-modulated radiotherapy (IMRT)-based stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC). A prospective database of 16 consecutive patients receiving SBRT for pathologically-proven and peripherally-located stage I NSCLC was reviewed. Fifteen patients were medically inoperable and one patient refused to undergo surgery. The median age of the patients was 76 years (range, 69-86). Treatment planning used four-dimensional computed tomography and fixed-field IMRT (n=11) or volumetric-modulated arc therapy (VMAT; n=5). The SBRT scheme was 48 Gy in four fractions (n=9) or 55 Gy in five fractions (n=7), delivered on consecutive days. The overall response rate at 6 months was 78.6%, including a complete response in three (21.4%) patients and a partial response in eight (57.1%). Three patients (21.4%) demonstrated a stable disease status. The median follow-up time was 14 months (range, 6-20) for the surviving patients. One patient developed local failure at 11 months, while another suffered from regional failure in a subcarinal lymph node at 4 months. Two patients did not survive within the first 6 months; one patient died during salvage chemotherapy for mediastinal lymph node metastasis and the other succumbed to a cause unrelated to lung cancer. The Kaplan-Meier estimates of local failure-free, progression-free and overall survival rates at 18 months were 91.0, 85.2 and 87.5%, respectively. The toxicity was mild; no severe (grade ≥3) toxicity was identified. IMRT-based (including VMAT) delivery of SBRT for patients with stage I NSCLC demonstrated favorable responses and local control without severe toxicity.

View Figures

View References

1	Chang MY and Sugarbaker DJ: Surgery for early stage non-small cell lung cancer. Semin Surg Oncol. 21:74–84. 2003. View Article : Google Scholar : PubMed/NCBI
2	Baumann P, Nyman J, Hoyer M, et al: Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol. 27:3290–3296. 2009. View Article : Google Scholar
3	Rowell NP and Williams CJ: Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review. Thorax. 56:628–638. 2001. View Article : Google Scholar
4	Qiao X, Tullgren O, Lax I, Sirzen F and Lewensohn R: The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer. 41:1–11. 2003. View Article : Google Scholar : PubMed/NCBI
5	Buyyounouski MK, Balter P, Lewis B, et al: Stereotactic body radiotherapy for early-stage non-small-cell lung cancer: report of the ASTRO Emerging Technology Committee. Int J Radiat Oncol Biol Phys. 78:3–10. 2010. View Article : Google Scholar : PubMed/NCBI
6	Nagata Y, Takayama K, Matsuo Y, et al: Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys. 63:1427–1431. 2005. View Article : Google Scholar : PubMed/NCBI
7	Timmerman R, Paulus R, Galvin J, et al: Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 303:1070–1076. 2010. View Article : Google Scholar : PubMed/NCBI
8	Bral S, Gevaert T, Linthout N, et al: Prospective, risk-adapted strategy of stereotactic body radiotherapy for early-stage non-small-cell lung cancer: results of a Phase II trial. Int J Radiat Oncol Biol Phys. 80:1343–1349. 2011. View Article : Google Scholar : PubMed/NCBI
9	Taremi M, Hope A, Dahele M, et al: Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Int J Radiat Oncol Biol Phys. 82:967–973. 2012. View Article : Google Scholar : PubMed/NCBI
10	Onishi H, Shirato H, Nagata Y, et al: Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2(7 Suppl 3): S94–S100. 2007. View Article : Google Scholar
11	Benedict SH, Cardinale RM, Wu Q, Zwicker RD, Broaddus WC and Mohan R: Intensity-modulated stereotactic radiosurgery using dynamic micro-multileaf collimation. Int J Radiat Oncol Biol Phys. 50:751–758. 2001. View Article : Google Scholar : PubMed/NCBI
12	Videtic GM, Stephans K, Reddy C, et al: Intensity-modulated radiotherapy-based stereotactic body radiotherapy for medically inoperable early-stage lung cancer: excellent local control. Int J Radiat Oncol Biol Phys. 77:344–349. 2010. View Article : Google Scholar
13	McGrath SD, Matuszak MM, Yan D, Kestin LL, Martinez AA and Grills IS: Volumetric modulated arc therapy for delivery of hypofractionated stereotactic lung radiotherapy: A dosimetric and treatment efficiency analysis. Radiother Oncol. 95:153–157. 2010. View Article : Google Scholar : PubMed/NCBI
14	Keall P: 4-dimensional computed tomography imaging and treatment planning. Semin Radiat Oncol. 14:81–90. 2004. View Article : Google Scholar : PubMed/NCBI
15	Grills IS, Hugo G, Kestin LL, et al: Image-guided radiotherapy via daily online cone-beam CT substantially reduces margin requirements for stereotactic lung radiotherapy. Int J Radiat Oncol Biol Phys. 70:1045–1056. 2008. View Article : Google Scholar : PubMed/NCBI
16	Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL and Trotti A: AJCC Cancer Staging Manual. 7th edition. Springer; New York: 2010
17	No authors listed. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 284:3043–3045. 2000. View Article : Google Scholar : PubMed/NCBI
18	The Radiation Therapy Oncology Group Clinical Trials (Available from: http://www.rtog.org/ClinicalTrials/ProtocolTable.aspx).
19	Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 45:228–247. 2009. View Article : Google Scholar
20	Mohammed N, Grills IS, Wong CY, et al: Radiographic and metabolic response rates following image-guided stereotactic radiotherapy for lung tumors. Radiother Oncol. 99:18–22. 2011. View Article : Google Scholar : PubMed/NCBI
21	Hof H, Rhein B, Haering P, Kopp-Schneider A, Debus J and Herfarth K: 4D-CT-based target volume definition in stereotactic radiotherapy of lung tumours: comparison with a conventional technique using individual margins. Radiother Oncol. 93:419–423. 2009.
22	Balter JM, Ten Haken RK, Lawrence TS, Lam KL and Robertson JM: Uncertainties in CT-based radiation therapy treatment planning associated with patient breathing. Int J Radiat Oncol Biol Phys. 36:167–174. 1996. View Article : Google Scholar : PubMed/NCBI
23	Underberg RW, Lagerwaard FJ, Cuijpers JP, Slotman BJ, van Sörnsen de Koste JR and Senan S: Four-dimensional CT scans for treatment planning in stereotactic radiotherapy for stage I lung cancer. Int J Radiat Oncol Biol Phys. 60:1283–1290. 2004. View Article : Google Scholar : PubMed/NCBI
24	Cardinale RM, Benedict SH, Wu Q, Zwicker RD, Gaballa HE and Mohan R: A comparison of three stereotactic radiotherapy techniques; ARCS vs. noncoplanar fixed fields vs intensity modulation. Int J Radiat Oncol Biol Phys. 42:431–436. 1998. View Article : Google Scholar : PubMed/NCBI
25	Holt A, van Vliet-Vroegindeweij C, Mans A, Belderbos JS and Damen EM: Volumetric-modulated arc therapy for stereotactic body radiotherapy of lung tumors: a comparison with intensity-modulated radiotherapy techniques. Int J Radiat Oncol Biol Phys. 81:1560–1567. 2011. View Article : Google Scholar : PubMed/NCBI
26	Yaes RJ, Patel P and Maruyama Y: On using the linear-quadratic model in daily clinical practice. Int J Radiat Oncol Biol Phys. 20:1353–1362. 1991. View Article : Google Scholar : PubMed/NCBI
27	Palma D and Senan S: Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. Curr Opin Oncol. 23:133–139. 2011. View Article : Google Scholar : PubMed/NCBI
28	Stephans KL, Djemil T, Reddy CA, et al: A comparison of two stereotactic body radiation fractionation schedules for medically inoperable stage I non-small cell lung cancer: the Cleveland Clinic experience. J Thorac Oncol. 4:976–982. 2009. View Article : Google Scholar : PubMed/NCBI