Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

Temming, Susanne; Köcher, Martin; Stoelben, Erich; Hagmeyer, Lars; Chang, De‐Hua; Frank, Konrad; Hekmat, Khosro; Wolf, Juergen; Baus, Wolfgang; Semrau, R.; Baues, Christian; Marnitz, Simone

doi:10.1007/s00066-017-1194-x

Cited by 28 publications

(35 citation statements)

References 33 publications

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“…The development of modern radiation technologies ensures that these elderly, frail patients can be treated safely. [30][31][32] The results of the current study stand in contrast to a SEER analysis by Shaikh et al, which shows that CSS and on univariate analysis -OS are better in patients without histologically confirmed disease. 25 More than 7000 patients were included, 90% of which had pathology.…”

Section: Discussioncontrasting

confidence: 91%

“…Simultaneously, the adoption of screening programs for lung cancer will lead to the detection of numerous small lesions in high‐risk populations in potentially limited general condition, which may preclude invasive diagnostic procedures. The development of modern radiation technologies ensures that these elderly, frail patients can be treated safely …”

Section: Discussionmentioning

confidence: 99%

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Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

et al. 2019

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BackgroundApproximately 15% of lung cancer patients are diagnosed in early stages. Microscopic proof of disease cannot always be obtained because of comorbidity or reluctance to undergo invasive diagnostic procedures. In the current study, survival data of patients with and without pathology are compared.MethodsOne hundred and sixty three patients with NSCLC I–IIb (T3 N0) treated between 2002 and 2016 were eligible: 123 (75%) had pathological confirmation of disease, whereas 40 (25%) did not. In accordance with international guidelines, both groups received radiotherapy. Comorbidity was assessed with the Charlson Comorbidity Index (CCI).ResultsThe median follow‐up was 28.6 months (range: 0.3–162): 66 (40%) patients are still alive, while 97 (59%) patients died: 48 (29%) cancer‐related deaths and 49 (30%) from causes other than cancer. Median overall survival (OS) in patients without pathological confirmation was 58.6 months (range: 0.5–162), which did not differ from those with microscopic proof of disease (39.4 months, range: 0.3–147.5; logrank P = 0.481). Median cancer‐specific survival (CSS) also did not differ at 113.4 months (range: 0.5–162) in the non‐confirmation group (logrank P = 0.763) versus 51.5 months (range: 3.7–129.5) in patients with pathology. In Cox regression, a CCI of ≥ 3 was associated with poor OS (hazard ratio 2.0; range 1.2–3.4; P = 0.010) and CSS (hazard ratio 2.0; 1.0–4.0; P = 0.043).ConclusionOS and CSS in early lung cancer patients depend on comorbidity rather than on pathological confirmation of disease.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

et al. 2019

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“…First of all, our LC rates are well in line with results from previous series of lung SBRT and specifically CyberKnife SBRT ( 5 , 7 – 9 , 13 , 21 – 24 , 51 – 54 ). We found that the PTV prescription BED 10 was a significant factor for LC which is in agreement with our previous and with large multi-institutional studies ( 5 , 7 – 9 , 13 , 38 , 39 , 55 , 56 ).…”

Section: Discussionsupporting

confidence: 91%

Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

et al. 2018

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IntroductionWe retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean dose optimized stereotactic body radiation therapy (SBRT) for primary and secondary lung tumors with and without robotic real-time motion compensation.Materials and methodsBetween 2011 and 2017, 208 patients were treated with SBRT for 111 primary lung tumors and 163 lung metastases with a median GTV of 8.2 cc (0.3–174.0 cc). Monte Carlo dose optimization was performed prioritizing GTV mean dose at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The median GTV mean biological effective dose (BED)10 was 162.0 Gy10 (34.2–253.6 Gy10) and the prescribed PTV BED10 ranged 23.6–151.2 Gy10 (median, 100.8 Gy10). Motion compensation was realized through direct tracking (44.9%), fiducial tracking (4.4%), and internal target volume (ITV) concepts with small (≤5 mm, 33.2%) or large (>5 mm, 17.5%) motion. The local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity were analyzed.ResultsMedian follow-up was 14.5 months (1–72 months). The 2-year actuarial LC, PFS, and OS rates were 93.1, 43.2, and 62.4%, and the median PFS and OS were 18.0 and 39.8 months, respectively. In univariate analysis, prior local irradiation (hazard ratio (HR) 0.18, confidence interval (CI) 0.05–0.63, p = 0.01), GTV/PTV (HR 1.01–1.02, CI 1.01–1.04, p < 0.02), and PTV prescription, mean GTV, and maximum plan BED10 (HR 0.97–0.99, CI 0.96–0.99, p < 0.01) were predictive for LC while the tracking method was not (p = 0.97). For PFS and OS, multivariate analysis showed Karnofsky Index (p < 0.01) and tumor stage (p ≤ 0.02) to be significant factors for outcome prediction. Late radiation pneumonitis or chronic rip fractures grade 1–2 were observed in 5.3% of the patients. Grade ≥3 side effects did not occur.ConclusionRobotic SBRT is a safe and effective treatment for lung tumors. Reducing the PTV prescription and keeping high GTV mean doses allowed the reduction of toxicity while maintaining high local tumor control. The use of real-time motion compensation is strongly advised, however, well-performed ITV motion compensation may be used alternatively when direct tracking is not feasible.

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“…Two studies assessed the toxicity and efficacy of IGSBR in a high-risk population of patients with early stage but medically inoperable lung cancer (IOLC). [ 18 , 19 ] One concluded that patients with nonsmall cell IOLC received SBRT had a survival rate of 55.8% at 3 years. [ 18 ] In addition, it also had high rates of local tumor control, and moderate treatment-related morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the other one demonstrated that IGSBR allows for real-time tumor tracking and also the risk-adapted fractionation achieves satisfactory local control and low toxicity rates in patients with IOLC at early stage. [ 19 ] The other study compared the effects between central and peripheral stage I lung cancer using IGSBR by helical tomotherapy. [ 20 ] It is found that helical IGSBR for the treatment of central stage I lung cancer is safe and effective, when it is compared with the patients in peripheral stage I lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of image-guidance radiotherapy by helical tomotherapy in patients with lung cancer

Chen

Dong²,

Zhang³

et al. 2018

Medicine

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This study aimed to explore the efficacy and toxicity of image-guided stereotactic body radiotherapy (IGSBR) by helical tomotherapy in patients with lung cancer among Chinese Han population.A total of 21 patients with stage I lung cancer were included. They received a total of 60 Gy factions IGSBR. The outcomes included complete response (CR), partial response (PR), stable disease (SD), progress disease (PD), overall response rate (ORR), and overall survival (OS). In addition, toxicities were also recorded in this study.Three-year CR, PR, SD, PD, ORR, and OS were 47.6%, 38.1%, 9.5%, 4.8%, 85.7%, and 48.0 months, respectively. Additionally, mild toxicities were found in this study.This study demonstrated that IGSBR is efficacious for patients with stage I lung cancer with mild toxicities among Chinese Han population.

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Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

Abstract: CyberKnife® lung SBRT which allows for real-time tumor tracking and risk-adapted fractionation achieves satisfactory local control and low toxicity rates in inoperable early-stage primary lung cancer patients.

Cited by 28 publications

References 33 publications

Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

Efficacy and safety of image-guidance radiotherapy by helical tomotherapy in patients with lung cancer

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