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Helical image-guided stereotactic body radiotherapy (SBRT) for the treatment of earlystage lung cancer: a single-institution experience at the Willis-Knighton Cancer Center

Abstract

Aims and background. Our aim is to report on the clinical methods and outcomes of helical intensity-modulated stereotactic body radiotherapy (SBRT) for the treatment of early-stage non-small cell lung cancer (NSCLC).
Methods and study design. Seventy-nine patients with stage I NSCLC underwent helical SBRT with 48 Gy in 4 fractions or 60 Gy in 5 fractions. All patients underwent 18Ffluorodeoxyglucose (FDG) positron emission tomography (PET) or FDG-PET/computed tomography (CT) scanning in the immobilized treatment position for planned fusion with a separate kilovoltage (KV) CT simulation prior to treatment. Megavoltage CT images were obtained on the treatment unit prior to therapy and repeated at midfraction with comparison and fusion to the KV CT simulation planning images to assure setup accuracy. Serial follow-up with FDG-PET or FDG-PET/CT was performed at 3-4 months and every 6 months thereafter.
Results. Median follow-up was 27 months (range, 4-82 months). Overall local control rate (LCR) was 93.6% (95% confidence interval [CI], 86.0-97.3%) and 3-year overall survival (OS) was 58.4% (95% CI, 47.2-69.5%). For patients with T1N0M0 disease (n = 59) the LCR was 94.9% (95% CI, 86.1-98.3%) and the 3-year OS was 62.8% (95% CI, 49.9-73.9%). Patients treated with 60 Gy had longer 3-year OS than patients treated with 48 Gy (65.2% vs 37.5%; P = 0.044). SBRT-related toxicity was modest, with 10 patients developing grade 1/2 chest wall toxicity based on the Common Terminology Criteria for Adverse Events (CTCAE).
Conclusion. Image-guided SBRT with helical IMRT delivered in 4 or 5 fractions of 12 Gy with rigid immobilization, FDG-PET-assisted targeting, and repeat mid-fraction CT scan is an effective treatment for early NSCLC.

Tumori 2014; 100(1): 42 - 48

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.1700/1430.15814

Authors

Lane R Rosen, Benjamin W Fischer-Valuck, Sanford R Katz, Michael Durci, Hsinshun Terry Wu, Joseph Syh, Jarron Syh, Bijal Patel

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Authors

  • Rosen, Lane R [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Fischer-Valuck, Benjamin W [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Katz, Sanford R [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Durci, Michael [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Wu, Hsinshun Terry [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Syh, Joseph [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Syh, Jarron [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA
  • Patel, Bijal [PubMed] [Google Scholar]
    Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, LA, USA

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