CyberKnife® Radiosurgery for Stage I Lung Cancer: Results at 36 Months

Brown, W. Ted; Wu, Xiaodong; Fayad, Fahed; Fowler, J. F.; Amendola, Beatriz E.; García, Silvio; Han, Hoke; Zerda, Alberto de la; Bossart, Elizabeth; Huang, Zichong; Schwade, James G.

doi:10.3816/clc.2007.n.033

Cited by 80 publications

(56 citation statements)

References 27 publications

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“…Five patients (3%) had pre-treatment radiological features of idiopathic pulmonary fibrosis (IPF). Histological diagnosis was (3)(4)(5). Total treatment time included an average of 20 minutes for patient set-up, followed by a median treatment time of 21 minutes (range 11-41 minutes).…”

Section: Patients Characteristicsmentioning

confidence: 99%

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Bahig

Filion

et al. 2014

Technol Cancer Res Treat

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The aim of this study is to report outcomes and prognostic factors for early stage non-small cell lung cancer treated with patient-adapted Cyberknife stereotactic body radiotherapy. A retrospective analysis of 150 patients with T1-2N0 non-small cell lung cancer treated with stereotactic body radiotherapy was conducted. An algorithm based on tumor and patient's characteristics was used to orient patients towards soft tissue (Xsight Lung), fiducials or adjacent bone (Xsight Spine) tracking. Median biological effective dose without correction for tissue inhomogeneities was 180 Gy 10 for peripheral tumors and 113 Gy 10 for central tumors. Median follow-up was 22 months. Actuarial 2 years local control, overall survival and disease-specific survival were respectively 96%, 87% and 95%. Every 1 cm increase in tumor diameter was associated with a relative risk for regional or distant relapse of 2 (95%CI 5 1.2-3.6, p 5 0.009). With doses 132 Gy 10 and 132 Gy 10 , local control was 98% vs. 82% (p 5 0.07), disease-specific survival 97% vs. 78% (p 5 0.02) and overall survival 93% vs. 76% (p 5 0.01), respectively. Better disease-specific survival and a trend for better overall survival was observed for peripheral vs. central tumors (96% vs. 79%, p 5 0.05 and 92% vs. 74%, p 5 0.08, respectively). A higher Charlson comordibity score (4) predicted lower overall survival (79% vs. 98%, p 5 0.01). Toxicities included 3 patients with idiopathic pulmonary fibrosis who developed grade 5 pneumonitis and 2 patients with grade 3 pneumonitis.We therefore report excellent local control and disease-specific survival following patientadapted Cyberknife lung stereotactic body radiotherapy. Although toxicities were in general minimal, patients with pulmonary fibrosis might be at greater risk of severe complications.Small size, peripheral location, dose  132 Gy 10 and a low Charlson co-morbidity score seem to be associated with better outcomes.

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Section: Patients Characteristicsmentioning

confidence: 99%

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Bahig

Filion

et al. 2014

Technol Cancer Res Treat

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“…It was even proposed originally for photons [Keall et al, 2001] and later implemented clinically in x-ray radiosurgery in the robotic Cyberknife Synchrony system (Accuray Inc., Sunnyvale, Ca., USA) [Brown et al, 2007, Kilby et al, 2010. Regardless of a radiation type, a fast beam delivery system is required for beam tracking.…”

Section: Motion Typesmentioning

confidence: 99%

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

et al. 2016

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Stereotactic body image guided radiation therapy (SBRT) shows excellent results for the local control of early stage lung cancer. However, not all patients are eligible for SBRT, and advanced stage treatment is less successful and often associated with severe side effects. Scanned carbon ion therapy (PT) can deliver more conformal dose likely benefiting these patient groups.Therefore an in silico trial was conducted on early and advanced stage patients to identify potential advantages of PT. The patients were treated with SBRT at Champalimaud Center for the Unknown, Lisbon (Portugal). PT plans were simulated on 4DCTs, and rescanning was investigated for motion mitigation in 4D-dose calculations. A dedicated strategy for 4D intensity modulated particle therapy (IMPT) was developed and applied for advanced stage patients with multiple lesions. For clinically valid and reliable results the deformable image registrationnecessary for 4D-dose calculation -a quality assurance tool was developed and applied in the study.The results showed that target coverage was comparable in SBRT and PT, while PT delivered significantly lower doses to most critical structures, especially the heart, lungs, and esophagus.A highly complex case of advanced stage lung cancer could be treated in a single fraction of 24 Gy with PT, while SBRT could not deliver the full ablative dose treatment due to an excessive heart dose. The mean heart dose was reduced from 10 Gy to 0.8 Gy with PT for this specific patient.

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“…Squamous cell carcinomas were treated with margins of 4 mm and 2 mm to cover microscopic extension and uncertainty, respectively. The CyberKnife radiosurgical technique for lung tumors has been described in several previous reports from our group [19][20][21][22][23]. The total system accuracy of the device and the respiratory motion tracking in a phantom has been reported as 1 mm in two recent articles [27,28].…”

Section: Treatment Dosementioning

confidence: 99%

Individualized higher dose of 70–75 Gy using five-fraction robotic stereotactic radiotherapy for non-small-cell lung cancer: A feasibility study

Brown

Fayad²,

Hevezi³

et al. 2011

Computer Aided Surgery

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Objective: To determine whether robotic stereotactic radiotherapy of 70-75 Gy delivered in five fractions results in an improved therapeutic ratio, compared with three fractions, in the treatment of peripheral non-small-cell lung cancer (NSCLC), in which case doses of up to 85 Gy in five fractions may be feasible. Materials and Methods: Between December 2006 and May 2010, 20 patients (9 female, 11 male, aged 65 to 88) were treated using the CyberKnife Õ Robotic Radiosurgery System for NSCLC with doses ranging from 67 Gy to 75 Gy based on location, histopathological type, grade of histopathological differentiation, tumor diameter/volume, and normal tissue constraints, with the doses being delivered in five fractions over 5 to 8 days. Tumor diameters ranged from 1.5 cm to 3.4 cm (median: 2.5 cm). Patients with Stage I to IV NSCLC were treated, and the results and observations were analyzed for clinical characteristics and outcomes including toxicity. All patients, except one who had refused surgery, had co-morbid conditions that precluded a lobectomy. Results: Twenty patients were followed every three months by positron emission tomography/computed tomography (PET/ CT). Mean follow-up was 23 months (range: four to 58 months). Local control was achieved in all treated tumors. Three patients expired, and three developed new regional metastases, none of which was within the planning target volume (PTV). The remainder of the patients demonstrated no evidence of recurrence or continued growth detectable by PET/ CT. There was no toxicity above Grade 1. Conclusions: It is feasible to treat peripheral NSCLC with individualized maximal tolerable doses ranging from 67 Gy to 75 Gy in five fractions chosen on the basis of location, histopathological type, grade of histopathological differentiation, tumor diameter/volume, and normal tissue constraints.

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CyberKnife® Radiosurgery for Stage I Lung Cancer: Results at 36 Months

Cited by 80 publications

References 27 publications

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

Individualized higher dose of 70–75 Gy using five-fraction robotic stereotactic radiotherapy for non-small-cell lung cancer: A feasibility study

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