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Clinical Trial
. 2010 Oct 15:5:94.
doi: 10.1186/1748-717X-5-94.

Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc

Marta Scorsetti  1 , Pierina Navarria, Pietro Mancosu, Filippo Alongi, Simona Castiglioni, Raffaele Cavina, Luca Cozzi, Antonella Fogliata, Sara Pentimalli, Angelo Tozzi, Armando Santoro
Affiliations
Clinical Trial

Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc

Marta Scorsetti et al. Radiat Oncol. .

Abstract

Background: To report acute toxicity, initial outcome results and planning therapeutic parameters in radiation treatment of advanced lung cancer (stage III) with volumetric modulated arcs using RapidArc (RA).

Methods: Twenty-four consecutive patients were treated with RA. All showed locally advanced non-small cell lung cancer with stage IIIA-IIIB and with large volumes (GTV:299 ± 175 cm3, PTV:818 ± 206 cm3). Dose prescription was 66Gy in 33 fractions to mean PTV. Delivery was performed with two partial arcs with a 6 MV photon beam.

Results: From a dosimetric point of view, RA allowed us to respect most planning objectives on target volumes and organs at risk. In particular: for GTV D1% = 105.6 ± 1.7%, D99% = 96.7 ± 1.8%, D5%-D95% = 6.3 ± 1.4%; contra-lateral lung mean dose resulted in 13.7 ± 3.9Gy, for spinal cord D1% = 39.5 ± 4.0Gy, for heart V45Gy = 9.0 ± 7.0Gy, for esophagus D1% = 67.4 ± 2.2Gy. Delivery time was 133 ± 7s. At three months partial remission > 50% was observed in 56% of patients. Acute toxicities at 3 months showed 91% with grade 1 and 9% with grade 2 esophageal toxicity; 18% presented grade 1 and 9% with grade 2 pneumonia; no grade 3 acute toxicity was observed. The short follow-up does not allow assessment of local control and progression free survival.

Conclusions: RA proved to be a safe and advantageous treatment modality for NSCLC with large volumes. Long term observation of patients is needed to assess outcome and late toxicity.

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Figures

Figure 1
Figure 1
A case of partial remission. Up: pre-treatment; Center: dose distribution; Down: 6 months after end of the therapy.
Figure 2
Figure 2
Isodose distributions for one example patient for an axial plane, sagittal and coronal views. Doses are shown in colorwash within the interval from 7 to 71Gy. GTV, PTV, and organs at risk are outlined as solid lines. Figure legend text.
Figure 3
Figure 3
Average dose volume histograms for GTV, PTV, organs at risk and healthy tissue. Dashed lines represent inter-patient variability at 1 standard deviation.
See this image and copyright information in PMC

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