Feasibility of stereotactic radiotherapy for lung lesions and conventional radiotherapy for nodal areas in primary lung malignancies

Yeon Joo Kim,Si Yeol Song,Su Ssan Kim,Eun Kyung Choi

doi:10.1186/s13014-018-1071-5

Yeon Joo Kim, Si Yeol Song + Show 2 more

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https://doi.org/10.1186/s13014-018-1071-5

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Abstract

BackgroundCombined stereotactic body radiotherapy (SBRT) for lung lesions and conventional radiotherapy (CRT) for nodal areas may be more effective than CRT alone in patients with locally advanced lung cancer.MethodsThis study included 21 patients with small primary lung tumors distant from the regional nodal areas. The SBRT dose was 40–60 Gy in 4 fractions. CRT doses were 66 Gy in 30 fractions for non-small cell lung cancer and 52.5 Gy in 25 fractions for small cell lung cancer.ResultsThe median follow-up duration was 12 months, and the median survival was 13 months. The 1 year overall survival, local recurrence-free survival, and distant metastasis-free survival rates were 60.5, 84.8, and 62.1%, respectively. Two patients experienced in-field local recurrence combined with out-field regional recurrence and/or distant failure. The major recurrence pattern was distant failure (crude incidence, 43%). Three patients aged ≥79 years experienced grade ≥ 3 acute radiation pneumonitis, and one also had idiopathic interstitial pneumonia.ConclusionThe combination of SBRT for the lung lesion and CRT for the nodal region seems to be effective and safe for lung malignancies. However, patients older in age and/or with underlying pulmonary disease require stricter lung dose constraints.

Highlights

Combined stereotactic body radiotherapy (SBRT) for lung lesions and conventional radiotherapy (CRT) for nodal areas may be more effective than CRT alone in patients with locally advanced lung cancer
Median patient age was 68 years, and their initial or recurrent clinical stages were classified as stages IIA (n = 4), IIIA (n = 8), and IIIB (n = 9)
Seven patients were treated with SBRT using three-dimensional conformal RT (3D-CRT), whereas 13 received volumetric arc therapy

Summary

Introduction

Combined stereotactic body radiotherapy (SBRT) for lung lesions and conventional radiotherapy (CRT) for nodal areas may be more effective than CRT alone in patients with locally advanced lung cancer. Definitive concurrent chemoradiotherapy (CCRT) has been recommended as the standard treatment for unresectable or medically inoperable stage II–III non-small cell lung cancer (NSCLC), based on the findings of randomized prospective trials [1,2,3]. Definitive CCRT is the treatment of choice for limited-stage small cell lung cancer (LS-SCLC), as indicated by two previous meta-analyses [4, 5]. The common radiotherapy dose regimens include conventional radiotherapy (CRT) with 60–66 Gy (1.8–2 Gy/fraction once daily) for NSCLC and 45 Gy (1.5 Gy/fraction twice daily) or higher doses (60–70 Gy in 2 Gy/fraction once daily) for small cell lung cancer (SCLC). In contrast to the concept that all tumors should receive the same radiation regimens, different radiotherapy regimens could be administered to each target in these patients

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