Stereotactic hypofractionated high‐dose irradiation for stage I nonsmall cell lung carcinoma

Abstract

BACKGROUND Stereotactic irradiation (STI) has been actively performed using various methods to achieve better local control of Stage I nonsmall cell lung carcinoma (NSCLC) in Japan. The authors retrospectively evaluated results from a Japanese multiinstitutional study. METHODS Patients with Stage I NSCLC (n = 245; median age, 76 years; T1N0M0, n=155; T2N0M0, n=90) were treated with hypofractionated high‐dose STI in 13 institutions. Stereotactic three‐dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. A total dose of 18–75 gray (Gy) at the isocenter was administered in 1–22 fractions. The median calculated biologic effective dose (BED) was 108 Gy (range, 57–180 Gy). RESULTS During follow‐up (median, 24 months; range, 7–78 months), pulmonary complications of National Cancer Institute‐Common Toxicity Criteria Grade > 2 were observed in only 6 patients (2.4%). Local progression occurred in 33 patients (14.5%), and the local recurrence rate was 8.1% for BED ≥ 100 Gy compared with 26.4% for < 100 Gy (P < 0.05). The 3‐year overall survival rate of medically operable patients was 88.4% for BED ≥ 100 Gy compared with 69.4% for < 100 Gy (P < 0.05). CONCLUSIONS Hypofractionated high‐dose STI with BED < 150 Gy was feasible and beneficial for curative treatment of patients with Stage I NSCLC. For all treatment methods and schedules, local control and survival rates were better with BED ≥ 100 Gy compared with < 100 Gy. Survival rates in selected patients (medically operable, BED ≥ 100 Gy) were excellent, and were potentially comparable to those of surgery. Cancer 2004. © 2004 American Cancer Society.

Stereotactic body radiotherapy for colorectal liver metastases

“…By comparison, Onishi et al have showed that a BED 100 Gy provided a 92% local control rate for medically inoperable early stage lung cancer in a series with nearly twice the median follow-up (2 years compared with 1.2 years in the present series). 34 The mechanism for this increased radioresistance is not well understood. It is possibly a difference in mean tumor volume between the 2 studies, but it also suggests a more aggressive nature of liver metastases because of selection of more aggressive clonogens capable of metastasizing and forming viable liver tumors.…”

SBRT: A viable option for treating adrenal gland metastases

“…These data are consistent with that indicating that a BED greater or equal to 100 Gy is necessary to control primary NSCLC. 29,30 One-and 2-year overall survival (OS) rate ranged from 39.7 to 90% and 13 to 53%, respectively, and was largely influenced by the development of widespread distant metastases. However, the selection of patients seemed to have a strong impact on these data, especially with regard to the type of metastasis (isolated vs. not isolated), the state of oligometastatic disease as defined by Hellman and Weichselbaum 10 and the time of onset of the adrenal metastasis (synchronous vs. metachronous).…”

Increased Motility and Invasiveness in Tumor Cells That Survive 10 Gy Irradiation

“…Recent developments in radiotherapy technology, such as intensity-modulated radiation therapy (IMRT) and three-dimensional (3D) radiotherapy, allow precise energy transfer to the tumor, which has improved local control rates (Onishi et al, 2004;Palazzi et al, 2009). However, the emergence of tolerant cells during or after radiotherapy remains problematic (Peters et al, 1985;Peters et al, 1982).…”