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Clinical Trial
. 2006 Aug 20:1:30.
doi: 10.1186/1748-717X-1-30.

Stereotactic, single-dose irradiation of stage I non-small cell lung cancer and lung metastases

Peter Fritz  1 , Hans-Jörg Kraus, Werner Mühlnickel, Udo Hammer, Wolfram Dölken, Walburga Engel-Riedel, Assad Chemaissani, Erich Stoelben
Affiliations
Clinical Trial

Stereotactic, single-dose irradiation of stage I non-small cell lung cancer and lung metastases

Peter Fritz et al. Radiat Oncol. .

Abstract

Background: We prospectively reviewed response rates, local control, and side effects after non-fractionated stereotactic high single-dose body radiation therapy for lung tumors.

Methods: Fifty-eight patients underwent radiosurgery involving single-dose irradiation. With 25 patients, 31 metastases in the lungs were irradiated; with each of 33 patients, stage I non-small cell lung cancer (NSCLC) was subject to irradiation. The standard dose prescribed to the isocenter was 30 Gy with an axial safety margin of 10 mm and a longitudinal safety margin of 15 mm. The planning target volume (PTV) was defined using three CT scans with reference to the phases of respiration so that the movement span of the clinical target volume (CTV) was enclosed.

Results: The volume of the metastases (CTV) varied from 2.8 to 55.8 cm3 (median: 6.0 cm3) and the PTV varied from 12.2 to 184.0 cm3 (median: 45.0 cm3). The metastases ranged from 0.7 to 4.5 cm in largest diameter. The volume of the bronchial carcinomas varied from 4.2 to 125.4 cm3 (median: 17.5 cm3) and the PTV from 15.6 to 387.3 cm3 (median: 99.8 cm3). The bronchial carcinomas ranged from 1.7 to 10 cm in largest diameter. Follow-up periods varied from 6.8 to 63 months (median: 22 months for metastases and 18 months for NSCLC). Local control was achieved with 94% of NSCLC and 87% of metastases. No serious symptomatic side effects were observed. According to the Kaplan-Meier method the overall survival probability rates of patients with lung metastases were as follows: 1 year: 97%, 2 years: 73%, 3 years: 42%, 4 years: 42%, 5 years: 42% (median survival: 26 months); of those with NSCLC: 1 year: 83%, 2 years: 63%, 3 years: 53%, 4 years: 39%: (median survival: 20.4 months).

Conclusion: Non-fractionated single-dose irradiation of metastases in the lungs or of small, peripheral bronchial carcinomas is an effective and safe form of local treatment and might become a viable alternative to invasive techniques.

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Figures

Figure 1
Figure 1
Image fusion of three dynamic CT scans in a reconstructed sagittal plane for determining target position (CTV) during respiration. (Green line: normal inhalation, pink line: naturally contracted position of the chest, blue line: normal exhalation, red line: PTV.) Tilting the tumor in x and y axes during respiration facilitates the phase-specific display of the CTVs.
Figure 2
Figure 2
planning target volume (red line formula image) and dose distribution for single-dose irradiation of a bronchial carcinoma using six coplanar portals (course of remission see figures figures 3a, b, c, d).
Figure 3
Figure 3
a, b, c, d: (a) bronchial carcinoma before single-dose irradiation with 30 Gy, (b) partial remission after 10 months, (c) complete remission 21 months after irradiation leaving a scarlike fibrosis. (d) dense consolidation after 48 months.
Figure 4
Figure 4
probability of local control (FFLF = freedom from local failure):---------- metastases, formula image NSCLC
Figure 5
Figure 5
probability of overall survival : --------- metastases, formula image NSCLC.
Figure 6
Figure 6
Respiratory functions (FEV 1) after stereotactic single-dose irradiation (●metastases, formula imagebronchial carcinomas, median and range values for patients (n) alive and available at the specified follow-up periods).
See this image and copyright information in PMC

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