Preliminary investigation of stereotactic body radiation therapy for medically inoperable stage Ⅰ / Ⅱ non-small cell lung cancer

( views:144, downloads:0 )
Author:
GUO Jin-dong(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
L(U) Chang-xing(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
WANG Jia-ming(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
LIU Jun(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
LI Hong-xuan(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
WANG Chang-lu(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
GAO Lan-ting(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
ZHAO Lei(Department of Radiation Oncology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China)
Journal Title:
CHINESE JOURNAL OF RADIATION ONCOLOGY
Issue:
Volume 20, Issue 01, 2011
DOI:
10.3760/cma.j.issn.1004-4221.2011.01.007
Key Word:
Carcinoma, non-small cell lung/radiotherapy;Radiotherapy, stereotactic;Treatment outcome

Abstract: Objective To evaluate the therapeutic efficacy and treatment-related toxicity of stereotactic body radiation therapy(SBRT)in patients with medically inoperable stage Ⅰ/Ⅱ non-small cell lung cancer(NSCLC). Methods SBRT was applied to 30 patients, including clinically staged T1 ,T2(≤5cm)or T3(chest wall primary tumors only), N0, M0 ,biopsy-confirmed NSCLC. All patients were precluded from lobotomy because of physical condition or comorbidity. No patients developed tumors of any T-stage in the proximal zone. SBRT was performed with the total dose of 50 Gy to 70 Gy in 10 - 11 fractions during 12 - 15 days. prescription line was set onthe edge of the PTV. Results The follow-up rate was 100%. The number of patients who completed the 1-, and 2-year follow-up were 15, and 10, respectively. All 30 patients completed therapy as planned. The complete response(CR), partial response(PR)and stable disease(SD)rates were 37%, 53% and 3%, respectively. With a median follow-up of 16 months(range,4-36 months), Kaplan-Meier local control at 2 years was 94%. The 2-year overall survival was 84% and the 2-year cancer specific survival was 90%. Seven patients(23%)developed Grade 2 pneumonitis, no grade > 2 acute or late lung toxicity was observed. No one developed chest wall pain. Conclusions It is feasible to deliver 50 Gy to 70 Gy of SBRT in 10 - 11 fractions for medically inoperable patients with stage Ⅰ / Ⅱ NSCLC. It was associated with low incidence of toxicities and provided sustained local tumor control.The preliminary investigation indicated the cancer specific survival probability of SBRT was high. It is necessary to perform similar investigation in a larger number of patients with long-term follow-up.

  • [1]Jemal A,Siegel R,Ward E,et al.Cancer statistics,2008.CA Cancer J Clin,2008,58:71-96.
  • [2]Scott WJ,Howington J,Feigenberg S,et al.Treatment of nonsmall cell lung cancer stage Ⅰ and stage Ⅱ:ACCP evidence-based clinical practice guidelines(2nd edition).Chest,2007,132(3 Suppl):234-242.
  • [3]Raz DJ,Zell JA,Ignatius OS,et al.Natural history of stage Ⅰ non-small cell lung cancer:implications for early detection.Chest,2007,132:193-199.
  • [4]Patrick T,Susan GA,Elizabeth A.New guidelines to evaluate the response to treatment in solid tumors.J Natl Cancer Inst,2000,92:205-215.
  • [5]National Cancer Institute.Cancer therapy evaluation program,common terminology criteria for adverse events.version 3.0.Washington:NCI,2003.
  • [6]Ginberg RJ,Rubinstein LV.Lung Cancer Study Group(1995)Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer.Ann Thorac Surg,1995,60:615-623.
  • [7]Mountain CF.A new international staging system for lung cancer.Chest,1986,89:225-233.
  • [8]Naruke T.Prognosis and survival in resected lung carcinoma based on the new international staging system.J Thorac Cardiovasc Surg,1988,96:440-447.
  • [9]Armstrong JG,Minsky BD.Radiation therapy for medically inoperable stage Ⅰ and Ⅱ non-small cell lung cancer.Cancer Treat Rev,1989,16:247-255.
  • [10]Haffty BG,Goldberg NB,Gerstley J,et al.Results of radical radiation therapy in clinical stage Ⅰ,technically operable nonsmall cell lung cancer.Int J Radiat Oncol Biol Phys,1988,15:69-73.
  • [11]Onishi H,Araki T,Shirato H,et al.Stereotactic hypofractionated high-dose irradiation for stage Ⅰ nonsmall cell lung carcinoma:clinical outcomes in 245 subjects in a Japanese multiinstitutional study.Cancer,2004,101:1623-1631.
  • [12]Timmerman RD,McGarry R,Yiannoutsos C,et al.Excessive toxicity when treating central tumors in a phase Ⅱ study of stereotactic body radiation therapy for medically inoperable earlystage lung cancer.J Clin Oncol,2006,24:483-439.
  • [13]Koto M,Takai Y,Ogawa Y,et al.A phase Ⅱ study on stereotactic body radiotherapy for stage Ⅰ non-small cell lung cancer.Radiother Oncol,2007,85:429-434.
  • [14]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,2005,63:1427-1431.
  • [15]Ginsberg RJ,Rubinstein LV.Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer.Ann Thorac Surg,1995,60:615-623.
  • [16]Nakamura HMP,Kazuyuki S,Kawasaki NM,et al.History of limited resection for non-small cell lung cancer.Ann Thorac Cardiovasc Surg,2005,11:356-362.
  • [17]Timmerman R,Papiez L,McGarry R,et al.Extracranial stereotacti cradioablation:results of a phase Ⅰ study in medically inoperable stage Ⅰ non-small cell lung cancer.Chest,2003;124:1946-1955.
  • [18]Krol AD,Aussems P,Noordijk EM,et al.Local irradiation alone for peripheral stage Ⅰ lung cancer:could we omit the elective regional nodal irradiation? Int J Radiat Oncol Biol Phys,1996,34:297-302.
  • [19]Williams TE,Thomas CR,Jr,Turrisi AT,Ⅲ.Counterpoint:better radiation treatment of non-small cell lung cancer using new techniques without elective nodal irradiation.Semin Radiat Oncol,2000,10:308-314.
  • [20]Baumann P,Nyman J,Lax I,et al.Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage Ⅰ lung cancer.A retrospective analysis of patients treated in the Nordic countries.Acta Oncol,2006,45:787-795.
  • [21]Fritz P,Kraus HJ,Muhlnickel W,et al.Stereotactic,single-dose irradiation of stage Ⅰ non-small cell lung cancer and lung metastases.Radiat Oncol,2006,1:30.
  • [22]Zimmermann FB,Geinitz H,Schill S,et al.Stereotactic hypofraction-ated radiation therapy for stage Ⅰ non-small cell lung cancer.Lung Cancer,2005,48:107-114.
  • [23]Machtay M,Hsu C,Komaki R,et al.Effect of overall treatment time on outcomes after concurrent chemoradiation or locally advanced non-small-cell lung carcinoma:analysis of the radiation therapy oncology group(RTOG)experience.Int J Radiat Oncol Biol Phys,2005,63:667-671.
  • [24]Chang JY,Balter P,Liao Z,et al.Preliminary report of imageguided hypofractionated stereotactic body radiotherapy to treat patients with medically inoperable stage Ⅰ or isolated peripheral lung recurrent non-small cell lung cancer.Int J Radiat Oncol Biol Phys,2006,66:480-481.
  • [25]Voroney JPJ,Hope A,Dahele MR,et al.Pain and rib fracture after stereotactic radiotherapy for peripheral non-small cell lung cancer.Int J Radiat Oncol Biol Phys,2008,2:35-36.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn