Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Body Radiotherapy for Pulmonary Nodular Lesions

Kawase, Takatsugu; Takeda, Atsuya; Kunieda, Etsuo; Kitajima, Masaki; Kamikubo, Y.; Ishibashi, R.; Nagaoka, Tomoaki; Shigematsu, Naoyuki; Kubo, Atsushi

doi:10.1016/j.ijrobp.2008.08.072

Cited by 16 publications

(5 citation statements)

References 37 publications

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“…Overall the prospect of chest wall toxicity remains mild in comparison with surgical alternatives [14]. Similar symptoms such as soft-tissue fibrosis [45], skin reaction [46], and brachial plexopathy [47] have been described; however, these occur in less than 1% of treatments and are likewise preventable with changes in treatment planning.…”

Section: Sbrt Results In Medically Inoperable Lung Cancer: Toxicitymentioning

confidence: 94%

The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

Videtic

Stephans

2010

Curr Oncol Rep

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The standard of care for early-stage lung cancer is surgical resection. Many patients with this diagnosis have comorbidities that preclude oncologic resection. Randomized data show that limited resection is inadequate for local disease control and may negatively impact on survival. Stereotactic body radiotherapy (SBRT) has emerged as a novel radiation modality with significant applications in the inoperable, early-stage lung cancer population. Retrospective and prospective studies published in the past decade have established the feasibility, safety, and efficacy of SBRT in these patients using a variety of dose regimens and technologies. To date, lung SBRT results demonstrate excellent local control with very little acute toxicity, and suggest improved overall survival compared to historical controls of fractionated radiotherapy. Ongoing prospective trials are exploring dose and fractionation schedules in the inoperable population, and are starting to explore the role of SBRT for the operable patient.

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Section: Sbrt Results In Medically Inoperable Lung Cancer: Toxicitymentioning

confidence: 94%

The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

Videtic

Stephans

2010

Curr Oncol Rep

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“…Stereotactic Body Radiation Therapy (SBRT) with its merits of dosimetry has been used for peripheral lung cancer recently. Several studies showed incidence of late CW toxicity after SBRT reporting wide variation ranging from less than 5% to as high as 25% (17).…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography (CT)-guided Interstitial Permanent Implantation of ¹²⁵I Seeds for Refractory Chest Wall Metastasis or Recurrence

Jiang

Liu

Wang

et al. 2015

Technol Cancer Res Treat

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To evaluate the efficacy and safety of 125I seeds implantation for refractory chest wall (CW) metastasis or recurrence under CT guidance. In addition we assessed initial data obtained on the therapeutic response for refractory CW metastasis or recurrence. Twenty consecutive patients underwent permanent implantation of 125I seeds (from Jul. 2004 to Jan. 2011) under computed tomography (CT) guidance. Postoperative dosimetry was routinely performed for all patients. The actuarial D90 of the implanted 125I seeds ranged from 100 Gy to 160 Gy (median: 130 Gy). The activity of 125I seeds ranged from 0.5 mCi to 0.78 mCi (median: 0.71 mCi). The total number of seeds implanted ranged from 8 to 269 (median: 53). The follow-up period ranged from 3 to 54 months (median: 11.5 months). The survival and local control probabilities were calculated by the Kaplan-Meier method. Among all the 20 patients, 3 patients had complete remission CR (15%), 12 patients had partial remission PR (60%), 5 patients had stable disease SD. The 1-, 2-, 3- and 4-year tumor control rates were all 88.7% respectively. The 1- and 2-, 3-, 4-year cancer specific survival rates were 56.5% and 47.1%, 47.1%, 47.1% respectively. The 1- and 2-, 3-, 4-year overall survival rates were 53.3% and 35.6%, 35.6%, 35.6% respectively, with a median survival of 15 months (95% CI, 7.0-22.9). Mild brachial plexus injury was seen in one patient; grade 1 or 2 skin reactions were seen in 6 patients (30%) who had received external beam radiation therapy (EBRT) before. No grade 3 and 4 skin side effects were found. Rib fracture, ulceration, pneumothorax or hemopneumothorax were not seen. Interstitial permanent implantation of 125I seeds under CT guidance is feasible, efficacious and safe for refractory CW metastasis or recurrence.

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“…Maximum dose of >26Gy (in four fractions) was associated with a 46% risk of developing plexopathy by two years. Chang et al (14) reported one case of partial arm paralysis after 20% of the brachial plexus received ≥40Gy in four fractions and Kawase et al (15) observed thumb numbness in a patient that received an estimated mean dose of 47Gy in five fractions to the brachial plexus. In a review of 104 spinal metastasis treated with single-fraction SAbR, Yamada et al (16) observed no case of radiculopathy even though the spinal nerve roots often received the prescription dose of 18–24Gy.…”

Section: Discussionmentioning

confidence: 99%

Paralysis following stereotactic spinal irradiation in pigs suggests a tolerance constraint for single-session irradiation of the spinal nerve

Medin

Foster

Kogel

et al. 2013

Radiotherapy and Oncology

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Background and Purpose Paralysis observed during a study of vertebral bone tolerance to single-session irradiation led to further study of the dose-related incidence of motor peripheral neuropathy. Materials and Methods During a bone tolerance study, cervical spinal nerves of 15 minipigs received bilateral irradiation to levels C5–C8 distributed into three dose groups with mean maximum spinal nerve doses of 16.9±0.3Gy(n=5), 18.7±0.5Gy(n=5), and 24.3±0.8Gy(n=5). Changes developing in the gait of the group of pigs receiving a mean maximum dose of 24.3 Gy after 10 – 15 weeks led to the irradiation of two additional animals. They received mean maximum dose of 24.9±0.2 Gy(n=2), targeted to the left spinal nerves of C5 – C8. The followup period was one year. Histologic sections from spinal cords and available spinal nerves were evaluated. MR imaging was performed on pigs in the 24.9Gy group. Results No pig that received a maximum spinal nerve point dose ≤19.0Gy experienced a change in gait while all pigs that received ≥24.1Gy experienced paralysis. Extensive degeneration and fibrosis were observed in irradiated spinal nerves from the 24.9Gy animals. All spinal cord sections were normal. Irradiated spinal nerve regions showed increased thickness and hypointensity on MR imaging. Conclusion The single-session tolerance dose of the cervical spinal nerves lies between 19.0 and 24.1 Gy for this model.

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Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Body Radiotherapy for Pulmonary Nodular Lesions

Cited by 16 publications

References 37 publications

The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

Computed Tomography (CT)-guided Interstitial Permanent Implantation of ¹²⁵I Seeds for Refractory Chest Wall Metastasis or Recurrence

Paralysis following stereotactic spinal irradiation in pigs suggests a tolerance constraint for single-session irradiation of the spinal nerve

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Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Body Radiotherapy for Pulmonary Nodular Lesions

Cited by 16 publications

References 37 publications

The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

The Role of Stereotactic Body Radiotherapy in the Management of Non-Small Cell Lung Cancer: An Emerging Standard for the Medically Inoperable Patient?

Computed Tomography (CT)-guided Interstitial Permanent Implantation of 125I Seeds for Refractory Chest Wall Metastasis or Recurrence

Paralysis following stereotactic spinal irradiation in pigs suggests a tolerance constraint for single-session irradiation of the spinal nerve

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Computed Tomography (CT)-guided Interstitial Permanent Implantation of ¹²⁵I Seeds for Refractory Chest Wall Metastasis or Recurrence