Dosimetric Selection for Helical Tomotherapy Based Stereotactic Ablative Radiotherapy for Early-Stage Non-Small Cell Lung Cancer or Lung Metastases

Chi, Alexander; Liao, Zhongxing; Nguyen, Nam P.; Xu, Jiahong; Welsh, James S.; Jang, Seonghoe; Howe, Carol; Komaki, Ritsuko

doi:10.1371/journal.pone.0035809

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…More than 430 000 people alive today in the US have been diagnosed with lung cancer . Treatment of lung cancer consists of chemotherapy, surgery, radiotherapy, targeted therapy, or combined therapy, and requires a prolonged process during which patients continuously experience uncertainty regarding curability and prognosis . In particular, during the terminal stages of cancer, patients may face a fear of death and feel hopelessness …”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with treatment refusal in lung cancer

et al. 2017

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BackgroundThe incidence of lung cancer is increasing with longer life expectancy. Refusal of active treatment for cancer is prone to cause patients to experience more severe symptoms and shorten survival. The purpose of this study was to define the factors related to refusal or abandonment of active therapy in lung cancer.MethodsWe retrospectively reviewed the data of 617 patients from medical records from 2010 to 2014. Two groups were formed: 149 patients who refused anti‐cancer treatment and allowed only palliative care were classified into the non‐treatment group, while the remaining 468 who received anti‐cancer treatment were classified into the treatment group.ResultsThe groups differed significantly in age, employment, relationship status, number of offspring, educational status, body mass index, presence of chest and systemic symptoms, Charlson Comorbidity Index, Eastern Cooperative Oncology Group score, and tumor node metastasis stage (P < 0.05). In logistic regression analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.07–1.13), educational status lower than high school (OR 1.95, 95% CI 1.2–3.2), no history of surgery (OR 2.29, 95% CI 1.4–3.7), body mass index < 18.5 (OR 2.49, 95% CI 1.3–4.7), and a high Eastern Cooperative Oncology Group score of 3 or 4 (OR 5.02, 95% CI 2.3–10.8) were significant factors for refusal of cancer treatment.ConclusionIndividual factors, such as old age, low educational status, low weight, and poor performance status can influence refusal of cancer treatment in patients with lung cancer, and should be considered prior to consultation with patients.

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Section: Introductionmentioning

confidence: 99%

Risk factors associated with treatment refusal in lung cancer

et al. 2017

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“…Severe toxicities in SBRT are mostly associated with close proximity to critical structures in the thorax. Therefore, some SBRT trials are ongoing for centrally located early stage NSCLC [7,8]. On the other hand, to our knowledge, no clinical reports of severe hemoptysis in SBRT for peripherally located lung tumors have been published.…”

Section: Discussionmentioning

confidence: 99%

“…4 Left bronchial arteriography shows slight hypervascularity at the left lung in accordance with the SBRT field (arrows) (a). The bronchial artery was embolized using gelatin sponge (GS) particles via a microcatheter inserted in the caudal branch (arrows) (b) and cranial branch (arrows) (c); GS particles were injected until the enhancement disappeared the treatment of centrally located lesions is currently underway [7].…”

Section: Discussionmentioning

confidence: 99%

A case of severe hemoptysis after stereotactic body radiotherapy for peripherally located stage I non-small cell lung cancer

et al. 2015

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In stereotactic body radiotherapy (SBRT) for centrally located non-small cell lung carcinoma (NSCLC), severe hemoptysis has been reported in several studies. We report here a rare case of hemoptysis after SBRT even though the lung tumor was peripherally located. A lung nodule of a 79-year-old man was accidentally found at the periphery of the left upper lobe. A computed tomography-guided biopsy of this nodule provided confirmation of the diagnosis of poorly differentiated adenocarcinoma. The clinical diagnosis was T1bN0M0, stage I primary lung cancer. The patient was treated with SBRT using helical tomotherapy at a dose of 60 Gy in 6 fractions (i.e., BED10 = 120). He obtained a complete response and did not experience recurrence. However, the patient suffered massive hemoptysis 4.5 years after SBRT. As hypervascularity of a left bronchial artery was observed at the left lung in accordance with SBRT field on bronchial arteriography, a bronchial artery embolization (BAE) procedure was performed. The patient has had no episodes of hemoptysis after BAE. Although SBRT for early stage NSCLC is usually safe and efficient, it is necessary to be careful for late-onset bronchial hemorrhage in SBRT, even for a peripheral tumor.

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“…They were optimized to have at least 95% of the PTV receiving 100% of the prescription dose with collapsed-cone convolution (CCC) algorithm for both HT and SA. Please refer to our previous study for details on the dose constraints used [27]. PTV coverage took precedence over OAR sparing in all plans.…”

Section: Methodsmentioning

confidence: 99%

Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

Chi

et al. 2013

PLoS ONE

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BackgroundHelical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) are both advanced techniques of delivering intensity-modulated radiotherapy (IMRT). Here, we conduct a study to compare HT and partial-arc VMAT in their ability to spare organs at risk (OARs) when stereotactic ablative radiotherapy (SABR) is delivered to treat centrally located early stage non-small-cell lung cancer or lung metastases.Methods12 patients with centrally located lung lesions were randomly chosen. HT, 2 & 8 arc (Smart Arc, Pinnacle v9.0) plans were generated to deliver 70 Gy in 10 fractions to the planning target volume (PTV). Target and OAR dose parameters were compared. Each technique’s ability to meet dose constraints was further investigated.ResultsHT and VMAT plans generated essentially equivalent PTV coverage and dose conformality indices, while a trend for improved dose homogeneity by increasing from 2 to 8 arcs was observed with VMAT. Increasing the number of arcs with VMAT also led to some improvement in OAR sparing. After normalizing to OAR dose constraints, HT was found to be superior to 2 or 8-arc VMAT for optimal OAR sparing (meeting all the dose constraints) (p = 0.0004). All dose constraints were met in HT plans. Increasing from 2 to 8 arcs could not help achieve optimal OAR sparing for 4 patients. 2/4 of them had 3 immediately adjacent structures.ConclusionHT appears to be superior to VMAT in OAR sparing mainly in cases which require conformal dose avoidance of multiple immediately adjacent OARs. For such cases, increasing the number of arcs in VMAT cannot significantly improve OAR sparing.

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Dosimetric Selection for Helical Tomotherapy Based Stereotactic Ablative Radiotherapy for Early-Stage Non-Small Cell Lung Cancer or Lung Metastases

Cited by 6 publications

References 31 publications

Risk factors associated with treatment refusal in lung cancer

Risk factors associated with treatment refusal in lung cancer

A case of severe hemoptysis after stereotactic body radiotherapy for peripherally located stage I non-small cell lung cancer

Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

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