Outcomes of Stereotactic Ablative Radiotherapy for Centrally Located Early-Stage Lung Cancer

Haasbeek, Cornelis J.A.; Lagerwaard, Frank J.; Slotman, Ben J.; Senan, Suresh

doi:10.1097/jto.0b013e31822e71d8

Cited by 222 publications

(177 citation statements)

References 38 publications

(43 reference statements)

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“…In the study by Fakiris et al, grades 3-5 toxicity occurred in 27% of patients with central lesions, compared to 10% of patients with peripheral tumors treated with a dose of 60-66 Gy in three fractions [15]. However, acceptable levels of early pulmonary toxicity have been reported for central lung lesions treated with less aggressive fractionation schemes such as 50-60 Gy in eight to ten fractions [16], 50 Gy in five fractions [17], 48 Gy in four fractions [18] and 60 Gy in eight fractions [19]. In all these studies, lung lesions are categorized as central or peripheral based solely on the nearest distance from the main bronchial tree.…”

Section: Discussionmentioning

confidence: 91%

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

et al. 2012

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Purpose: Stereotactic body radiation therapy is an emerging technique in the treatment of peripheral lung tumors. However, due to early reports of increased toxicity, the treatment of central lung lesions with hypo-fractionated high-dose regimen remains controversial. Thus far, lung lesions have been defined as either central or peripheral depending solely on their nearest distance from the major airways. The goal of this study is to develop a quantitative method to categorize the location of lung lesions mapped in three-dimensional space. Furthermore, a set of parameters are proposed for assessing risk factors based on target locations. Methods and Materials: A MATLAB program was developed to quantify the distance between the tumor and the airways, and to calculate the percentage of the target volume lying within a given distance from the main bronchial tree. The program was tested on 20 patients with centrally located lung lesions treated with CyberKnife. A dosimetric analysis was performed to investigate the relationship between dose delivered to the critical structures and target location. Results: The absolute target volume located within a distance of 20 mm from the airways was used to quantify the tumor proximity to the bronchial tree. A strong correlation was found between this parameter and the dose delivered to the critical organs, showing that a detailed knowledge of target location can be used to assess the risk of toxicity during the planning stage. Conclusions: We have developed a tool to quantify the lesion proximity to the bronchial tree. We expect that riskadapted strategies, accounting for the exact geometric relationship between the tumor and the airways, may improve the management of centrally located lung lesions.

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Section: Discussionmentioning

confidence: 91%

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

et al. 2012

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“…Zgodnie z propozycją Timmermana, na podstawie wyników badania RTOG 0236, jest to obszar w promieniu 2 cm od ściany tchawicy i głównych oskrzeli [4]. Definicja zaproponowana przez Haasbeecka to objętość zawarta w promieniu 1 cm od obszaru śródpiersia [7]. Guzy położone centralnie były do niedawna przeciwwskazaniem do SBRT.…”

Section: Stereotaktyczna Radioterapia I Radiochirurgia Wczesnego Rakaunclassified

Czy stereotaktyczna radioterapia stanowi równorzędną alternatywę dla chirurgii w I stopniu niedrobnokomórkowego raka płuca? Głos na TAK

Dziadziuszko¹

2015

Nowotwory. Journal of Oncology

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Wystąpienie podczas II Konferencji Naukowej czasopisma Nowotwory "Debaty onkologiczne" 11-12 kwietnia 2014 roku Czy stereotaktyczna radioterapia stanowi równorzędną alternatywę dla chirurgii w I stopniu niedrobnokomórkowego raka płuca? Głos na TAK Rafał DziadziuszkoStereotactic radiotherapy should be an alternative approach to surgery in stage I non-small cell lung cancer Stereotaktyczna radioterapia i radiochirurgia wczesnego raka płucaStereotaktyczna radioterapia i radiochirurgia są to bliskie sobie terminy, oznaczające zastosowanie wiązki promieniowania jonizującego w celach terapeutycznych w postaci kilku (stereotaktyczna radioterapia, SBRT) lub jednej (radiochirurgia, SRS) wysokiej dawki promieniowania zdeponowanej w stosunkowo niewielkim obszarze z bardzo wysoką precyzją i bardzo wysokim gradientem spadku dawki poza obszarem tarczowym. Techniki stereotaktycznej radioterapii, zapoczątkowane w leczeniu łagodnych i zło-śliwych zmian zlokalizowanych w ośrodkowym układzie nerwowym, zostały następnie wprowadzone do leczenia zmian pozaczaszkowych, w tym przede wszystkim do terapii wczesnych zmian nowotworowych w obrębie klatki piersiowej, u chorych z przeciwwskazaniami do leczenia operacyjnego lub niewyrażających zgody na to leczenie. Przeprowadzone w ciągu ostatnich dwóch dekad badania kliniczne doprowadziły do opracowania optymalnych sposobów frakcjonowania dawki (najczęściej stosowane schematy to 54 Gy w 3 frakcjach, 55 Gy w 5 frakcjach oraz 60 Gy w 8 frakcjach, w zależności od lokalizacji guza), algorytmów obliczania dawki (preferowane są zawansowane algorytmy typu B) oraz dawek dopuszczalnych dla narządów krytycznych [1]. Wykazano, że schematy frakcjonowania dawki, dla których całkowita dawka efektywna biologicznie (biologically effective dose -BED) jest niższa niż 100Gy, są związane z wyższym prawdopodobieństwem nawrotów miejscowych i krótszym czasem przeżycia w porównaniu ze schematami, dla których BED > 100 Gy [2]. Warunkiem zastosowania SBRT w leczeniu wczesnego raka płuca jest uzyskanie rozpoznania mikroskopowego (od tej zasady można odstąpić jedynie w przypadkach ryzyka znaczących powikłań po biopsji) oraz precyzyjna ocena stopnia zaawansowania z wykorzystaniem pozytonowej tomografii emisyjnej (PET-TK), planowanie z udziałem tomografii komputerowej 4D, zapewniającej uzyskanie skanów TK w synchronizacji z poszczególnymi fazami cyklu oddechowego, posiadanie odpowiedniego systemu planowania leczenia wraz z przeszkolonym zespołem lekarzy i fizyków medycznych, stosowanie monitorowania lokalizacji guza przed każdą frakcją radioterapii (image-guided radiotherapy -IGRT) oraz rutynowe stosowanie systemu kontroli jakości radioterapii z udokumentowanym audytem poszczególnych czynności wykonywanych w trakcie procedury. Do procedur SBRT w obszarze klatki piersiowej wykorzystuje się szereg urządzeń, najczęściej akceleratory wysokoenergetyczne z mikrokolimatorami wielolistkowymi lub akceleratory na ramieniu robotycznym. Synchronizacja wiązki z cyklem oddechowym w trakcie leczenia (gating) jest technicznie możliwa w p...

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“…Previous Japanese studies (41,44), which used lesser fractions without any tissue constraints revealed no differences in toxicity for the treatment of central versus peripheral tumours. A similar study in Europe has shown over 90% local control for a treatment program of 60 Gy in 8 fractions (7.5 Gy/fraction) for 3 years (18). RTOG recently finished the accrual for the 0813 trial, which is a dose escalation study, analysing doses from 50 Gy to 60 Gy (10 Gy to 12 Gy per fraction in 5 fractions).…”

Section: Central Tumoursmentioning

confidence: 99%

“…These include a conventional linear accelerator in fixed field mode (18) or dynamically with intensity modulated fixed field (intensity modulated radiotherapy -IMRT) (19) or arc technique (volumetric arc therapy commercially known as RapidArc or VMAT) (20). It can also be given using Tomotherapy (Wisconsin, USA) (a linear accelerator specifically designed to irradiate using the arc technique) (21) and with a robotic mounted linear accelerator (Cyberknife; Stanford,USA) (22).…”

Section: Sabr Techniquementioning

confidence: 99%

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

Akşit¹,

Yazıcı²,

Akşit³

et al. 2015

Balkan Med J

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Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Approximately 15 to 20% of NSCLC patients present with early or localised disease; this figure is expected to grow with the increased use of low-dose computed tomography (CT) scans for screening (1). The standard treatment for operable stage I NSCLC is lobectomy or pneumonectomy with mediastinal lymphadenectomy. Five-year survival rates of early stage NSCLC patients range between 60 and 80% after surgical resection (2). Despite major developments in minimally-invasive surgical procedures, a substantial proportion of patients are not suitable for surgery due to their comorbidities. Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) has recently emerged as a benchmark of care for medically inoperable patients. SABR is a more concise and well-planned treatment procedure with enhanced local control and survival while minimising treatment cost against conventional radiotherapy.Cancer-specific outcomes of patients in SABR series are generally comparable to surgical series; however, overall survival results are usually reported to be superior in the surgical cohorts because of major differences in the two groups.Approximately one in every three patient dies as a result of comorbidity-related complications instead of cancer in SBRT series. As a result, in patients with operable stage I NSCLC, surgical operation continues to be the benchmark of care. In this review, we plan to summarise the published evidence for the treatment of early stage NSCLC with surgery and SABR. THE SURGICAL MANAGEMENT OF EARLY STAGE NSCLCSurgical resection remains the treatment of choice for patients with stage I or II NSCLC, since it provides the optimal likelihood of cure and long-term survival. Such an operation includes both complete anatomical resection of the tumour and mediastinal lymph node evaluation (3). PREOPERATIVE EVALUATIONPatients with NSCLC who are surgical candidates are often cigarette smokers, which makes them vulnerable to atheroThe management of early-stage Non-small Cell Lung Cancer (NSCLC) has improved recently due to advances in surgical and radiation modalities. Minimallyinvasive procedures like Video-assisted thoracoscopic surgery (VATS) lobectomy decreases the morbidity of surgery, while the numerous methods of staging the mediastinum such as endobronchial and endoscopic ultrasound-guided biopsies are helping to achieve the objectives much more effectively. Stereotactic Ablative Radiotherapy (SABR) has become the frontrunner as the standard of care in medically inoperable early stage NSCLC patients, and has also been branded as tolerable and highly effective. Ongoing researches using SABR are continuously validating the optimal dosing and fractionation schemes, while at the same time instituting its role for both inoperable and operable patients.

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Outcomes of Stereotactic Ablative Radiotherapy for Centrally Located Early-Stage Lung Cancer

Abstract: Use of risk-adapted SABR delivered in eight fractions of 7.5 Gy did not result in excess toxicity for centrally located early-stage lung tumors, and clinical outcomes were comparable with those seen for peripheral lesions.

Cited by 222 publications

References 38 publications

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

Czy stereotaktyczna radioterapia stanowi równorzędną alternatywę dla chirurgii w I stopniu niedrobnokomórkowego raka płuca? Głos na TAK

Selenium Protects Retinal Cells from Cisplatin Induced Alterations in Carbohydrate Residues

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