Stereotactic body radiotherapy with helical TomoTherapy for medically inoperable early stage primary and second-primary non-small-cell lung neoplasm: 1-year outcome and toxicity analysis

Abstract

The authors Alban Lovis and Oscar Matzinger contributed equally to this article.Objective: This study investigated the effectiveness of stereotactic body radiotherapy with helical TomoTherapy (T-SBRT) for treating medically inoperable primary and second-primary early stage non-small-cell lung neoplasm (SPLN) and evaluated whether the movement of organizing pneumonia (OP) within the irradiation field (IF) can be detected via analysis of radiological changes. Methods: Patients (n 5 16) treated for 1 year (2011-12) at our hospital by T-SBRT at a total dose of 60 Gy in five fractions were examined retrospectively. Outcome and toxicity were recorded and were separately described for SPLN. CT scans were reviewed by a single radiologist. Results: Of the 16 patients, 5 (31.3%) had primary lung malignancies, 10 (62.5%) had SPLN, and 1 case (6.3%) had isolated mediastinal metastasis of lung neoplasm. Pathological evidence was obtained for 72.2% of all lesions. The median radiological follow-up was 11 months (10.5 months for SPLN). For all cases, the 6-and 12-month survival rates were 100% and 77.7% (100% and 71.4%, respectively, for SPLN), and the 6-and 12-month locoregional control rates were 100% in all cases. 2 (12.5%) of 16 patients developed grade 3 late transient radiation pneumonitis following steroid therapy and 1 (6.3%) presented asymptomatic infiltrates comparable to OP opacities. Conclusion: T-SBRT seems to be safe and effective. Advances in knowledge: Mild OP is likely associated with radiation-induced anomalies in the IF, identification of migrating opacities can help discern relapse of radiationinduced opacities.

Dosimetric comparison of helical tomotherapy and conventional Linac-based X-knife stereotactic body radiation therapy for primary lung cancer or pulmonary metastases

“…So, the application of MVCT can catch the change of tumor volume to achieve adaptive radiotherapy (31). Previous studies also confirmed the safety and effectiveness of tomotherapy for SBRT (32)(33)(34).…”

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

“…Owing to the aforementioned disadvantages of HT compared with other stereotactic treatments in this setting, HTT is slow to be adopted in clinical practice, and few studies-often evaluating small series of patients with inhomogeneous characteristics and short FU-are available in the recent literature [9][10][11][12][13][14][15][16] (Table 4). Several points can be gleaned from this study, which to our knowledge is one among the largest series addressing the use of HTT in the treatment of lung lesions.…”

“…5,6 While dosimetric findings have shown that such capabilities can potentially translate into the delivery of an increased tumour dose with doses to normal tissues decreased compared with other techniques, 7,8 only a limited number of patients were included in recent studies that have addressed the feasibility of hypofractionated or ablative radiotherapy (RT) regimens for lung tumours treated with HT. [9][10][11][12][13][14][15][16] Reasonable arguments might be advocated for its slow adoption in the clinical practice in this setting: during HT it is not only the tumour and the MLC that are moving but also the radiation source and couch, which can maximize the breathing interplay effect (i.e. difference between planned and delivered absorbed doses that arises from a mismatch between the tumour and the MLC because of motion).…”

Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients

“…In the study published by Ricardi et al [30], the most frequent side effects observed also included skin reactions like erythema. Conversely, in the same clinical series, sub-acute/late toxicity was quite uncommon and included two cases of grade C3 pneumonitis [30,31]. Onishi et al [3] reported a rib fracture and a grade 3 dermatitis in four (4.6 %) and three patients (3.4 %), respectively.…”