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. 2013 Mar 21:8:69.
doi: 10.1186/1748-717X-8-69.

Stereotactic body radiotherapy using gated radiotherapy with real-time tumor-tracking for stage I non-small cell lung cancer

Tetsuya Inoue  1 , Norio Katoh, Rikiya Onimaru, Shinichi Shimizu, Kazuhiko Tsuchiya, Ryusuke Suzuki, Jun Sakakibara-Konishi, Naofumi Shinagawa, Satoshi Oizumi, Hiroki Shirato
Affiliations

Stereotactic body radiotherapy using gated radiotherapy with real-time tumor-tracking for stage I non-small cell lung cancer

Tetsuya Inoue et al. Radiat Oncol. .

Abstract

Background: To clarify the clinical outcomes of two dose schedule of stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer (NSCLC) using a real-time tumor-tracking radiation therapy (RTRT) system in single institution.

Methods: Using a superposition algorithm, we administered 48 Gy in 4 fractions at the isocenter in 2005-2006 and 40 Gy in 4 fractions to the 95% volume of PTV in 2007-2010 with a treatment period of 4 to 7 days. Target volume margins were fixed irrespective of the tumor amplitude.

Results: In total, 109 patients (79 T1N0M0 and 30 T2N0M0). With a median follow-up period of 25 months (range, 4 to 72 months), the 5-year local control rate (LC) was 78% and the 5-year overall survival rate (OS) was 64%. Grade 2, 3, 4, and 5 radiation pneumonitis (RP) was experienced by 15 (13.8%), 3 (2.8%), 0, and 0 patients, respectively. The mean lung dose (MLD) and the volume of lung receiving 20 Gy (V20) were significantly higher in patients with RP Grade 2/3 than in those with RP Grade 0/1 (MLD p = 0.002, V20 p = 0.003). There was no correlation between larger maximum amplitude of marker movement and larger PTV (r = 0.137), MLD (r = 0.046), or V20 (r = 0.158).

Conclusions: SBRT using the RTRT system achieved LC and OS comparable to other SBRT studies with very low incidence of RP, which was consistent with the small MLD and V20 irrespective of tumor amplitude. For stage I NSCLC, SBRT using RTRT was suggested to be reliable and effective, especially for patients with large amplitude of tumor movement.

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Figures

Figure 1
Figure 1
Kaplan-Meier actuarial overall survival (OS) and local control (LC) rate.
Figure 2
Figure 2
Kaplan-Meier curve of overall survival (OS) rates for patients with T1a (n = 47) and T1b or T2 (n = 62). Significant statistical difference was found (p = 0.01) between the two groups.
Figure 3
Figure 3
(a) Correlation with planning target volume (PTV) and mean lung dose (MLD), (b) Correlation with PTV and the volume of lung receiving 20 Gy (V20).
Figure 4
Figure 4
(a) Correlation with maximum amplitude of marker movement and planning target volume (PTV), (b) Correlation with maximum amplitude of marker movement and mean lung dose (MLD), (c) Correlation with maximum amplitude of marker movement and the volume of lung receiving 20 Gy (V20).
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