Abstract
BackgroundRecent developments in radiotherapeutic technology have resulted in a new approach to treating patients with localized lung cancer. We report preliminary clinical outcomes using stereotactic radiosurgery with real-time tumor motion tracking to treat small peripheral lung tumors.MethodsEligible patients were treated over a 24-month period and followed for a minimum of 6 months. Fiducials (3–5) were placed in or near tumors under CT-guidance. Non-isocentric treatment plans with 5-mm margins were generated. Patients received 45–60 Gy in 3 equal fractions delivered in less than 2 weeks. CT imaging and routine pulmonary function tests were completed at 3, 6, 12, 18, 24 and 30 months.ResultsTwenty-four consecutive patients were treated, 15 with stage I lung cancer and 9 with single lung metastases. Pneumothorax was a complication of fiducial placement in 7 patients, requiring tube thoracostomy in 4. All patients completed radiation treatment with minimal discomfort, few acute side effects and no procedure-related mortalities. Following treatment transient chest wall discomfort, typically lasting several weeks, developed in 7 of 11 patients with lesions within 5 mm of the pleura. Grade III pneumonitis was seen in 2 patients, one with prior conventional thoracic irradiation and the other treated with concurrent Gefitinib. A small statistically significant decline in the mean % predicted DLCO was observed at 6 and 12 months. All tumors responded to treatment at 3 months and local failure was seen in only 2 single metastases. There have been no regional lymph node recurrences. At a median follow-up of 12 months, the crude survival rate is 83%, with 3 deaths due to co-morbidities and 1 secondary to metastatic disease.ConclusionRadical stereotactic radiosurgery with real-time tumor motion tracking is a promising well-tolerated treatment option for small peripheral lung tumors.
Highlights
Treatment options for medically inoperable patients with lung cancer are limited
Updated outcomes of a Phase I stereotactic body radiotherapy (SBRT) dose escalation study confirm that abbreviated radiosurgery treatment courses, in which doses in the range of 45 Gy to 60 Gy are delivered in less than 2 weeks, result in durable local control rates ranging from 70 to 90% [14]
We report preliminary clinical outcomes from 24 consecutive patients with single small peripheral lung tumors radically treated using Synchrony real-time tumor motion tracking
Summary
Treatment options for medically inoperable patients with lung cancer are limited. Poor outcomes with protracted conventionally fractionated radiotherapy approaches prompted researchers in the last decade to explore ways of delivering high doses of radiation in shorter periods of time [1]. Updated outcomes of a Phase I stereotactic body radiotherapy (SBRT) dose escalation study confirm that abbreviated radiosurgery treatment courses, in which doses in the range of 45 Gy to 60 Gy are delivered in less than 2 weeks, result in durable local control rates ranging from 70 to 90% [14]. Such favorable outcomes establish thoracic stereotactic radiosurgery as a new radical treatment option for small peripheral lung tumors. We report preliminary clinical outcomes using stereotactic radiosurgery with real-time tumor motion tracking to treat small peripheral lung tumors
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