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. 2017 Jan 5;12(1):3.
doi: 10.1186/s13014-016-0742-3.

Clinical outcomes of stage I and IIA non-small cell lung cancer patients treated with stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system

Norio Katoh  1   2 , Itaru Soda  3 , Hiroyasu Tamamura  4 , Shotaro Takahashi  5 , Yusuke Uchinami  6 , Hiromichi Ishiyama  3 , Kiyotaka Ota  4 , Tetsuya Inoue  7 , Rikiya Onimaru  6 , Keiko Shibuya  5 , Kazushige Hayakawa  3 , Hiroki Shirato  8   6
Affiliations

Clinical outcomes of stage I and IIA non-small cell lung cancer patients treated with stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system

Norio Katoh et al. Radiat Oncol. .

Abstract

Purpose: To investigate the clinical outcomes of stage I and IIA non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) using a real-time tumor-tracking radiotherapy (RTRT) system.

Materials and methods: Patterns-of-care in SBRT using RTRT for histologically proven, peripherally located, stage I and IIA NSCLC was retrospectively investigated in four institutions by an identical clinical report format. Patterns-of-outcomes was also investigated in the same manner.

Results: From September 2000 to April 2012, 283 patients with 286 tumors were identified. The median age was 78 years (52-90) and the maximum tumor diameters were 9 to 65 mm with a median of 24 mm. The calculated biologically effective dose (10) at the isocenter using the linear-quadratic model was from 66 Gy to 126 Gy with a median of 106 Gy. With a median follow-up period of 28 months (range 0-127), the overall survival rate for the entire group, for stage IA, and for stage IB + IIA was 75%, 79%, and 65% at 2 years, and 64%, 70%, and 50% at 3 years, respectively. In the multivariate analysis, the favorable predictive factor was female for overall survival. There were no differences between the clinical outcomes at the four institutions. Grade 2, 3, 4, and 5 radiation pneumonitis was experienced by 29 (10.2%), 9 (3.2%), 0, and 0 patients. The subgroup analyses revealed that compared to margins from gross tumor volume (GTV) to planning target volume (PTV) ≥ 10 mm, margins < 10 mm did not worsen the overall survival and local control rates, while reducing the risk of radiation pneumonitis.

Conclusions: This multi-institutional retrospective study showed that the results were consistent with the recent patterns-of-care and patterns-of-outcome analysis of SBRT. A prospective study will be required to evaluate SBRT using a RTRT system with margins from GTV to PTV < 10mm.

Keywords: Gated radiotherapy; Image-guided radiotherapy; Non-small cell lung cancer; Real-time tumor-tracking radiotherapy; Stereotactic body radiotherapy.

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Figures

Fig. 1
Fig. 1
Overall survival rates in all patients (a), patients with stage IA and with stage IB + IIA (b), respectively
Fig. 2
Fig. 2
Local control rates of all tumors (a), T1a + T1b tumors and T2a + T2b tumors (b), respectively
See this image and copyright information in PMC

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