Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2009 Jan 17:2:1.
doi: 10.1186/1756-8722-2-1.

Radical cyberknife radiosurgery with tumor tracking: an effective treatment for inoperable small peripheral stage I non-small cell lung cancer

Brian T Collins  1 , Saloomeh Vahdat, Kelly Erickson, Sean P Collins, Simeng Suy, Xia Yu, Ying Zhang, Deepa Subramaniam, Cristina A Reichner, Ismet Sarikaya, Giuseppe Esposito, Shadi Yousefi, Carlos Jamis-Dow, Filip Banovac, Eric D Anderson
Affiliations
Clinical Trial

Radical cyberknife radiosurgery with tumor tracking: an effective treatment for inoperable small peripheral stage I non-small cell lung cancer

Brian T Collins et al. J Hematol Oncol. .

Abstract

Objective: Curative surgery is not an option for many patients with clinical stage I non-small-cell lung carcinoma (NSCLC), but radical radiosurgery may be effective.

Methods: Inoperable patients with small peripheral clinical stage I NSCLC were enrolled in this study. Three-to-five fiducial markers were implanted in or near tumors under CT guidance. Gross tumor volumes (GTVs) were contoured using lung windows. The GTV margin was expanded by 5 mm to establish the planning treatment volume (PTV). A dose of 42-60 Gy was delivered to the PTV in 3 equal fractions in less than 2 weeks using the CyberKnife radiosurgery system. The 30-Gy isodose contour extended at least 1 cm from the GTV. Physical examination, CT imaging and pulmonary function testing were completed at 6 months intervals for three years following treatment.

Results: Twenty patients with an average maximum tumor diameter of 2.2 cm (range, 1.1 - 3.5 cm) and a mean FEV1 of 1.08 liters (range, 0.53 - 1.71 L) were treated. Pneumothorax requiring tube thoracostomy occurred following CT-guided fiducial placement in 25% of the patients. All patients completed treatment with few acute side effects and no procedure-related mortality. Transient chest wall discomfort developed in 8 of the 12 patients with lesions within 5 mm of the pleura. The mean percentage of the total lung volume receiving a minimum of 15 Gy was 7.3% (range, 2.4% to 11.3%). One patient who received concurrent gefitinib developed short-lived, grade III radiation pneumonitis. The mean percent predicted DLCO decreased by 9% and 11% at 6 and 12 months, respectively. There were no local failures, regional lymph node recurrences or distant metastases. With a median follow-up of 25 months for the surviving patients, Kaplan-Meier overall survival estimate at 2 years was 87%, with deaths due to COPD progression.

Conclusion: Radical CyberKnife radiosurgery is a well-tolerated treatment option for inoperable patients with small, peripheral stage I NSCLC. Effective doses and adequate margins are likely to have contributed to the optimal early local control seen in this study.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Right upper lobe clinical stage IA NSCLC treatment planning CT (A), planned radiation dose distribution (B: the planning treatment volume is shown in red and the 30 Gy isodose line in blue), and CT at 3 and 6 months post-treatment (C and D) show an initial decrease in the tumor volume followed by radiation fibrosis which correlates with the planned dose distribution, engulfs the fiducials and impedes evaluation of tumor response.
Figure 2
Figure 2
Kaplan-Meier plot of overall survival.
See this image and copyright information in PMC

References

    1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–622. doi: 10.1016/0003-4975(95)00537-U. discussion 622–613. - DOI - PubMed
    1. Swanson SJ, Herndon JE, 2nd, D'Amico TA, Demmy TL, McKenna RJ, Jr, Green MR, Sugarbaker DJ. Video-assisted thoracic surgery lobectomy: report of CALGB 39802 – a prospective, multi-institution feasibility study. J Clin Oncol. 2007;25:4993–4997. doi: 10.1200/JCO.2007.12.6649. - DOI - PubMed
    1. Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE, 2nd, Landreneau RJ, Inculet RI, Jones DR, Meyers BF, Harpole DH, Putnam JB, Jr, Rusch VW. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–1019. doi: 10.1016/j.athoracsur.2005.06.066. discussion 1019–1020. - DOI - PubMed
    1. Handy JR, Jr, Asaph JW, Skokan L, Reed CE, Koh S, Brooks G, Douville EC, Tsen AC, Ott GY, Silvestri GA. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest. 2002;122:21–30. doi: 10.1378/chest.122.1.21. - DOI - PubMed
    1. El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, Urda SJ, Luketich JD, Landreneau RJ. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82:408–415. doi: 10.1016/j.athoracsur.2006.02.029. discussion 415–406. - DOI - PubMed

Publication types

MeSH terms