Early Experience of Stereotactic Body Radiotherapy in Patients with Primary and Metastatic Lung Tumors

Hsin Lun Lee, Jo-Ting Tsai, Shang Wen Chen, Jia-Wei Lin, Wilson Tiu Lao, Kum Min Wang, Chiu-Ping Chen, Jeng-Fong Chiou, Tao Sang Chung

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate the clinical outcomes of patients with primary and metastatic lung tumors treated by CyberKnife(superscript ®) (CK) stereotactic body radiotherapy (SBRT).Methods: Between November 2005 and June 2008, we treated 19 patients with SBRT at Taipei Medical University-Wan Fang Hospital. The SBRT was delivered by CK tumor tracking system. Tumor response and treatment-related toxicity were evaluated by follow-up image study. Treatment-related toxicities were scored by Common Terminology Criteria for Adverse Events version 3.0. In this study, we reviewed their medical records retrospectively.Results: We treated 47 lung tumors in 19 patients using CK SBRT. Eleven tumors in 8 patients were primary lung cancer, and 36 tumors in 11 patients were metastatic lung cancer. The locations of 9 tumors were central, whereas the others were peripheral. The tumor volumes were ranged from 1.1 to 110.5 ml (median, 9.5 ml). The radiation doses were ranged from 22 to 60 Gy, given in 2 to 4 fractions. The prescribed doses were normalized at 76% to 85% of the planned isodose. With a median follow-up interval of 12 months, we observed that grade 2 radiation pneumonitis (RP) occurred in 3 patients (1 central; 2 peripheral), whereas we found that grade 3 RP occurred in 2 patients with central lesions. According to the univariate analysis, female (p=0.038) and central lesion (p=0.042) were two predictive factors to the occurrence of grade≥2 RP. One grade 4 tracheal complication (tracheoesophageal fistula) and one grade 5 bronchial complication (bronchial necrosis) were observed in two patients who had centrally located recurrent tumors and had been previous treated with external beam radiotherapy. Four of the evaluable patients (16 patients) had responded completely (25%), seven exhibited partial response to treatment (43.8%), and two had stable disease (12.5%). Three patients had tumor progression after SBRT (18.7%). The 1-year overall survival (OS) was 63%, and the 1-year local progression-free survival (PFS) was 84.2%. The 1-year local PFS was 87.5% for primary lung cancer and 81.8% for metastatic lung cancer (p=0.87). The 1-year local PFS for central and peripheral lesions was 80% and 85.7%, respectively (p=0.63).Conclusion: Our study showed that SBRT using the CK system was effective for treating primary and metastatic lung tumors, providing better local control and shorter treatment course compared with those treated with conventional fractionated radiotherapy. Our study also showed two predicting factors for RP. Finally, using SBRT to treat centrally located tumor or re-irradiate recurrent tumor require additional caution due to higher risk of having complication. Thus, we suggest that more studies are needed in the future to confirm those findings in this study.
Original languageEnglish
Pages (from-to)111-124
Number of pages14
Journal放射治療與腫瘤學
Volume18
Issue number2
DOIs
Publication statusPublished - 2011

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Radiosurgery
Lung
Radiation Pneumonitis
Neoplasms
Lung Neoplasms
Disease-Free Survival
Radiotherapy
Tracheoesophageal Fistula
Therapeutics
Tumor Burden
Terminology
Medical Records
Necrosis
Radiation

Keywords

  • 電腦刀
  • 立體定位體部放射治療
  • 肺腫瘤
  • 放射性肺炎
  • CyberKnife(superscript ®)
  • Stereotactic body radiotherapy
  • Lung tumor
  • Radiation pneumonitis

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Early Experience of Stereotactic Body Radiotherapy in Patients with Primary and Metastatic Lung Tumors. / Lee, Hsin Lun; Tsai, Jo-Ting; Chen, Shang Wen; Lin, Jia-Wei; Lao, Wilson Tiu; Wang, Kum Min; Chen, Chiu-Ping; Chiou, Jeng-Fong; Chung, Tao Sang.

In: 放射治療與腫瘤學, Vol. 18, No. 2, 2011, p. 111-124.

Research output: Contribution to journalArticle

Lee, Hsin Lun ; Tsai, Jo-Ting ; Chen, Shang Wen ; Lin, Jia-Wei ; Lao, Wilson Tiu ; Wang, Kum Min ; Chen, Chiu-Ping ; Chiou, Jeng-Fong ; Chung, Tao Sang. / Early Experience of Stereotactic Body Radiotherapy in Patients with Primary and Metastatic Lung Tumors. In: 放射治療與腫瘤學. 2011 ; Vol. 18, No. 2. pp. 111-124.
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abstract = "Purpose: To investigate the clinical outcomes of patients with primary and metastatic lung tumors treated by CyberKnife(superscript {\circledR}) (CK) stereotactic body radiotherapy (SBRT).Methods: Between November 2005 and June 2008, we treated 19 patients with SBRT at Taipei Medical University-Wan Fang Hospital. The SBRT was delivered by CK tumor tracking system. Tumor response and treatment-related toxicity were evaluated by follow-up image study. Treatment-related toxicities were scored by Common Terminology Criteria for Adverse Events version 3.0. In this study, we reviewed their medical records retrospectively.Results: We treated 47 lung tumors in 19 patients using CK SBRT. Eleven tumors in 8 patients were primary lung cancer, and 36 tumors in 11 patients were metastatic lung cancer. The locations of 9 tumors were central, whereas the others were peripheral. The tumor volumes were ranged from 1.1 to 110.5 ml (median, 9.5 ml). The radiation doses were ranged from 22 to 60 Gy, given in 2 to 4 fractions. The prescribed doses were normalized at 76{\%} to 85{\%} of the planned isodose. With a median follow-up interval of 12 months, we observed that grade 2 radiation pneumonitis (RP) occurred in 3 patients (1 central; 2 peripheral), whereas we found that grade 3 RP occurred in 2 patients with central lesions. According to the univariate analysis, female (p=0.038) and central lesion (p=0.042) were two predictive factors to the occurrence of grade≥2 RP. One grade 4 tracheal complication (tracheoesophageal fistula) and one grade 5 bronchial complication (bronchial necrosis) were observed in two patients who had centrally located recurrent tumors and had been previous treated with external beam radiotherapy. Four of the evaluable patients (16 patients) had responded completely (25{\%}), seven exhibited partial response to treatment (43.8{\%}), and two had stable disease (12.5{\%}). Three patients had tumor progression after SBRT (18.7{\%}). The 1-year overall survival (OS) was 63{\%}, and the 1-year local progression-free survival (PFS) was 84.2{\%}. The 1-year local PFS was 87.5{\%} for primary lung cancer and 81.8{\%} for metastatic lung cancer (p=0.87). The 1-year local PFS for central and peripheral lesions was 80{\%} and 85.7{\%}, respectively (p=0.63).Conclusion: Our study showed that SBRT using the CK system was effective for treating primary and metastatic lung tumors, providing better local control and shorter treatment course compared with those treated with conventional fractionated radiotherapy. Our study also showed two predicting factors for RP. Finally, using SBRT to treat centrally located tumor or re-irradiate recurrent tumor require additional caution due to higher risk of having complication. Thus, we suggest that more studies are needed in the future to confirm those findings in this study.",
keywords = "電腦刀, 立體定位體部放射治療, 肺腫瘤, 放射性肺炎, CyberKnife(superscript {\circledR}), Stereotactic body radiotherapy, Lung tumor, Radiation pneumonitis",
author = "Lee, {Hsin Lun} and Jo-Ting Tsai and Chen, {Shang Wen} and Jia-Wei Lin and Lao, {Wilson Tiu} and Wang, {Kum Min} and Chiu-Ping Chen and Jeng-Fong Chiou and Chung, {Tao Sang}",
year = "2011",
doi = "10.6316/TRO/201118(2)111",
language = "English",
volume = "18",
pages = "111--124",
journal = "放射治療與腫瘤學",
issn = "1023-988x",
publisher = "台灣放射腫瘤學會",
number = "2",

}

TY - JOUR

T1 - Early Experience of Stereotactic Body Radiotherapy in Patients with Primary and Metastatic Lung Tumors

AU - Lee, Hsin Lun

AU - Tsai, Jo-Ting

AU - Chen, Shang Wen

AU - Lin, Jia-Wei

AU - Lao, Wilson Tiu

AU - Wang, Kum Min

AU - Chen, Chiu-Ping

AU - Chiou, Jeng-Fong

AU - Chung, Tao Sang

PY - 2011

Y1 - 2011

N2 - Purpose: To investigate the clinical outcomes of patients with primary and metastatic lung tumors treated by CyberKnife(superscript ®) (CK) stereotactic body radiotherapy (SBRT).Methods: Between November 2005 and June 2008, we treated 19 patients with SBRT at Taipei Medical University-Wan Fang Hospital. The SBRT was delivered by CK tumor tracking system. Tumor response and treatment-related toxicity were evaluated by follow-up image study. Treatment-related toxicities were scored by Common Terminology Criteria for Adverse Events version 3.0. In this study, we reviewed their medical records retrospectively.Results: We treated 47 lung tumors in 19 patients using CK SBRT. Eleven tumors in 8 patients were primary lung cancer, and 36 tumors in 11 patients were metastatic lung cancer. The locations of 9 tumors were central, whereas the others were peripheral. The tumor volumes were ranged from 1.1 to 110.5 ml (median, 9.5 ml). The radiation doses were ranged from 22 to 60 Gy, given in 2 to 4 fractions. The prescribed doses were normalized at 76% to 85% of the planned isodose. With a median follow-up interval of 12 months, we observed that grade 2 radiation pneumonitis (RP) occurred in 3 patients (1 central; 2 peripheral), whereas we found that grade 3 RP occurred in 2 patients with central lesions. According to the univariate analysis, female (p=0.038) and central lesion (p=0.042) were two predictive factors to the occurrence of grade≥2 RP. One grade 4 tracheal complication (tracheoesophageal fistula) and one grade 5 bronchial complication (bronchial necrosis) were observed in two patients who had centrally located recurrent tumors and had been previous treated with external beam radiotherapy. Four of the evaluable patients (16 patients) had responded completely (25%), seven exhibited partial response to treatment (43.8%), and two had stable disease (12.5%). Three patients had tumor progression after SBRT (18.7%). The 1-year overall survival (OS) was 63%, and the 1-year local progression-free survival (PFS) was 84.2%. The 1-year local PFS was 87.5% for primary lung cancer and 81.8% for metastatic lung cancer (p=0.87). The 1-year local PFS for central and peripheral lesions was 80% and 85.7%, respectively (p=0.63).Conclusion: Our study showed that SBRT using the CK system was effective for treating primary and metastatic lung tumors, providing better local control and shorter treatment course compared with those treated with conventional fractionated radiotherapy. Our study also showed two predicting factors for RP. Finally, using SBRT to treat centrally located tumor or re-irradiate recurrent tumor require additional caution due to higher risk of having complication. Thus, we suggest that more studies are needed in the future to confirm those findings in this study.

AB - Purpose: To investigate the clinical outcomes of patients with primary and metastatic lung tumors treated by CyberKnife(superscript ®) (CK) stereotactic body radiotherapy (SBRT).Methods: Between November 2005 and June 2008, we treated 19 patients with SBRT at Taipei Medical University-Wan Fang Hospital. The SBRT was delivered by CK tumor tracking system. Tumor response and treatment-related toxicity were evaluated by follow-up image study. Treatment-related toxicities were scored by Common Terminology Criteria for Adverse Events version 3.0. In this study, we reviewed their medical records retrospectively.Results: We treated 47 lung tumors in 19 patients using CK SBRT. Eleven tumors in 8 patients were primary lung cancer, and 36 tumors in 11 patients were metastatic lung cancer. The locations of 9 tumors were central, whereas the others were peripheral. The tumor volumes were ranged from 1.1 to 110.5 ml (median, 9.5 ml). The radiation doses were ranged from 22 to 60 Gy, given in 2 to 4 fractions. The prescribed doses were normalized at 76% to 85% of the planned isodose. With a median follow-up interval of 12 months, we observed that grade 2 radiation pneumonitis (RP) occurred in 3 patients (1 central; 2 peripheral), whereas we found that grade 3 RP occurred in 2 patients with central lesions. According to the univariate analysis, female (p=0.038) and central lesion (p=0.042) were two predictive factors to the occurrence of grade≥2 RP. One grade 4 tracheal complication (tracheoesophageal fistula) and one grade 5 bronchial complication (bronchial necrosis) were observed in two patients who had centrally located recurrent tumors and had been previous treated with external beam radiotherapy. Four of the evaluable patients (16 patients) had responded completely (25%), seven exhibited partial response to treatment (43.8%), and two had stable disease (12.5%). Three patients had tumor progression after SBRT (18.7%). The 1-year overall survival (OS) was 63%, and the 1-year local progression-free survival (PFS) was 84.2%. The 1-year local PFS was 87.5% for primary lung cancer and 81.8% for metastatic lung cancer (p=0.87). The 1-year local PFS for central and peripheral lesions was 80% and 85.7%, respectively (p=0.63).Conclusion: Our study showed that SBRT using the CK system was effective for treating primary and metastatic lung tumors, providing better local control and shorter treatment course compared with those treated with conventional fractionated radiotherapy. Our study also showed two predicting factors for RP. Finally, using SBRT to treat centrally located tumor or re-irradiate recurrent tumor require additional caution due to higher risk of having complication. Thus, we suggest that more studies are needed in the future to confirm those findings in this study.

KW - 電腦刀

KW - 立體定位體部放射治療

KW - 肺腫瘤

KW - 放射性肺炎

KW - CyberKnife(superscript ®)

KW - Stereotactic body radiotherapy

KW - Lung tumor

KW - Radiation pneumonitis

U2 - 10.6316/TRO/201118(2)111

DO - 10.6316/TRO/201118(2)111

M3 - Article

VL - 18

SP - 111

EP - 124

JO - 放射治療與腫瘤學

JF - 放射治療與腫瘤學

SN - 1023-988x

IS - 2

ER -