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Open Access 01-12-2014 | Research

Changes in volume of stage I non-small-cell lung cancer during stereotactic body radiotherapy

Authors: Kotoha Tatekawa, Hiromitsu Iwata, Takatsune Kawaguchi, Satoshi Ishikura, Fumiya Baba, Shinya Otsuka, Akifumi Miyakawa, Maho Iwana, Yuta Shibamoto

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

The overall treatment time of stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer is usually 3 to over 10 days. If it is longer than 7 days, tumor volume expansion during SBRT may jeopardize the target dose coverage. In this study, volume change of stage I NSCLC during SBRT was investigated.

Methods

Fifty patients undergoing 4-fraction SBRT with a total dose of 48 Gy (n = 36) or 52 Gy (n = 14) were analyzed. CT was taken for registration at the first and third SBRT sessions with an interval of 7 days in all patients. Patient age was 29–87 years (median, 77), and 39 were men. Histology was adenocarcinoma in 28, squamous cell carcinoma in 17, and others in 5. According to the UICC 7th classification, T-stage was T1a in 9 patients, T1b in 27, and T2a in 14. Tumor volumes on the first and 8th days were determined on CT images taken during the exhalation phase, by importing the data into the Dr. View/LINAX image analysis system. After determining the optimal threshold for distinguishing tumor from pulmonary parenchyma, the region above -250 HU was automatically extracted and the tumor volumes were calculated.

Results

The median tumor volume was 7.3 ml (range, 0.5-35.7) on day 1 and 7.5 ml (range, 0.5-35.7) on day 8. Volume increase of over 10% was observed in 16 cases (32%); increases by >10 to ≤20%, >20 to ≤30%, and >30% were observed in 9, 5, and 2 cases, respectively. The increase in the estimated tumor diameter was over 2 mm in 3 cases and 1–2 mm in 6. A decrease of 10% or more was seen in 3 cases. Among the 16 tumors showing a volume increase of over 10%, T-stage was T1a in 2 patients, T1b in 9, and T2a in 5. Histology was adenocarcinoma in 10 patients, squamous cell carcinoma in 5, and others in 1.

Conclusions

Volume expansion >10% was observed in 32% of the tumors during the first week of SBRT, possibly due to edema or sustained tumor progression. When planning SBRT, this phenomenon should be taken into account.

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Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al.: Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys 2011, 81: 1352-1358. 10.1016/j.ijrobp.2009.07.1751CrossRefPubMed

Matsuo Y, Shibuya K, Nagata Y, Norihisa Y, Narabayashi M, Sakanaka K, et al.: Preliminary report of late recurrences, at 5 years or more, after stereotactic body radiation therapy for non-small cell lung cancer. J Thorac Oncol 2012, 7: 453-456. 10.1097/JTO.0b013e31823c5b29CrossRefPubMed

Chang JY, Liu H, Balter P, Komaki R, Liao Z, Welsh J, et al.: Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer. Radiat Oncol 2012, 7: 152. 10.1186/1748-717X-7-152PubMedCentralCrossRefPubMed

Shirata Y, Jingu K, Koto M, Kubozono M, Takeda K, Sugawara T, et al.: Prognostic factors for local control of stage I non-small cell lung cancer in stereotactic radiotherapy: a retrospective analysis. Radiat Oncol 2012, 7: 182. 10.1186/1748-717X-7-182PubMedCentralCrossRefPubMed

Matsuo Y, Shibuya K, Nagata Y, Takayama K, Norihisa Y, Mizowaki T, et al.: Prognostic factors in stereotactic body radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2011, 79: 1104-1111. 10.1016/j.ijrobp.2009.12.022CrossRefPubMed

Chi A, Liao Z, Nguyen NP, Xu J, Stea B, Komaki R: Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications. Radiother Oncol 2010, 94: 1-11. 10.1016/j.radonc.2009.12.008CrossRefPubMed

Andratschke N, Zimmermann F, Boehm E, Schill S, Schoenknecht C, Thamma R, et al.: Stereotactic radiotherapy of histologically proven inoperable stage I non-small cell lung cancer: patterns of failure. Radiother Oncol 2011, 101: 245-249. 10.1016/j.radonc.2011.06.009CrossRefPubMed

Koto M, Takai Y, Ogawa Y, Matsushita H, Takeda K, Takahashi C, et al.: A phase II study on stereotactic body radiotherapy for stage I non-small cell lung cancer. Radiother Oncol 2007, 85: 429-434. 10.1016/j.radonc.2007.10.017CrossRefPubMed

Reyngold M, Wu AJ, McLane A, Zhang Z, Hsu M, Stein NF, et al.: Toxicity and outcomes of thoracic re-irradiation using stereotactic body radiation therapy (SBRT). Radiat Oncol 2013, 8: 99. 10.1186/1748-717X-8-99PubMedCentralCrossRefPubMed

10.

Hiraoka M, Ishikura S: A Japan clinical oncology group trial for stereotactic body radiation therapy of non-small cell lung cancer. J Thorac Oncol 2007,7(Suppl 3):S115-S117.CrossRef

11.

Baba F, Shibamoto Y, Ogino H, Murata R, Sugie C, Iwata H, et al.: Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size. Radiat Oncol 2010, 5: 81. 10.1186/1748-717X-5-81PubMedCentralCrossRefPubMed

12.

Shibamoto Y, Hashizume C, Baba F, Ayakawa S, Manabe Y, Nagai A, et al.: Stereotactic body radiotherapy using a radiobiology-based regimen for stage I nonsmall cell lung cancer: a multicenter study. Cancer 2012, 118: 2078-2084. 10.1002/cncr.26470CrossRefPubMed

13.

Iwata H, Shibamoto Y, Baba F, Sugie C, Ogino H, Murata R, et al.: Correlation between the serum KL-6 level and the grade of radiation pneumonitis after stereotactic body radiotherapy for stage I lung cancer or small lung metastasis. Radiother Oncol 2011, 101: 267-270. 10.1016/j.radonc.2011.05.031CrossRefPubMed

14.

Shibamoto Y, Kitakabu Y, Murata R, Oya N, Shibata T, Sasai K, et al.: Reoxygenation in the SCCVII tumor after KU-2285 sensitization plus single or fractionated irradiation. Int J Radiat Oncol Biol Phys 1994, 29: 583-586. 10.1016/0360-3016(94)90461-8CrossRefPubMed

15.

Murata R, Shibamoto Y, Sasai K, Oya N, Shibata T, Takagi T, et al.: Reoxygenation after single irradiation in rodent tumors of different types and sizes. Int J Radiat Oncol Biol Phys 1996, 34: 859-865. 10.1016/0360-3016(95)02155-8CrossRefPubMed

16.

Shibamoto Y, Naruse A, Fukuma H, Ayakawa S, Sugie C, Tomita N: Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study. Radiother Oncol 2007, 84: 52-55. 10.1016/j.radonc.2007.05.015CrossRefPubMed

17.

Kosaki K, Shibamoto Y, Hirai T, Hatano M, Tomita N, Kobayashi T, et al.: Regression curves of brain metastases after gamma knife irradiation: difference by tumor and patient characteristics. Cancer Sci 2012, 103: 1967-1973. 10.1111/j.1349-7006.2012.02392.xCrossRefPubMed

18.

Miyakawa A, Shibamoto Y, Hashizume C, Kosaki K: Early response and local control of stage I non-small-cell lung cancer after stereotactic radiotherapy: difference by histology. Cancer Sci 2013, 104: 130-134. 10.1111/cas.12048CrossRefPubMed

19.

Shibamoto Y, Ike O, Mizuno H, Fukuse T, Hitomi H, Takahashi M: Proliferative activity and micronucleus frequency after radiation of lung cancer cells as assessed by the cytokinesis-block method and their relationship to clinical outcome. Clin Cancer Res 1998, 4: 677-682.PubMed

20.

Meyn RE, Stephens LC, Ang KK, Hunter NR, Brock WA, Milas L, et al.: Heterogeneity in the development of apoptosis in irradiated murine tumours of different histologies. Int J Radiat Biol 1993, 64: 583-591. 10.1080/09553009314551801CrossRefPubMed

21.

Underberg RWM, Lagerwaard FJ, van Tinteren H, Cuijpers JP, Slotman BJ, Senan S: Time trends in target volumes for stage I non–small-cell lung cancer after stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 2006, 64: 1221-1228. 10.1016/j.ijrobp.2005.09.045CrossRefPubMed

22.

Haasbeek CJA, Lagerwaard FJ, Cuijpers JP, Slotman BJ, Senan S: Is adaptive treatment planning required for stereotactic radiotherapy of stage I non–small-cell lung cancer? Int J Radiat Oncol Biol Phys 2007, 67: 1370-1374. 10.1016/j.ijrobp.2006.11.018CrossRefPubMed

23.

Matsugi K, Narita Y, Sawada A, Nakamura M, Miyabe Y, Matsuo Y, et al.: Measurement of interfraction variations in position and size of target volumes in stereotactic body radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys 2009, 75: 543-548. 10.1016/j.ijrobp.2008.12.091CrossRefPubMed

24.

Hof H, Rhein B, Haering P, Kopp-Schneider A, Debus J, Herfarth K: 4D-CT-based target volume definition in stereotactic radiotherapy of lung tumours: comparison with a conventional technique using individual margins. Radiother Oncol 2009, 93: 419-423. 10.1016/j.radonc.2009.08.040CrossRefPubMed

25.

Sweeney RA, Seubert B, Stark S, Homann V, Müller G, Flentje M, et al.: Accuracy and inter-observer variability of 3D versus 4D cone-beam CT based image-guidance in SBRT for lung tumors. Radiat Oncol 2012, 7: 81. 10.1186/1748-717X-7-81PubMedCentralCrossRefPubMed

26.

Wang L, Hayes S, Paskalev K, Jin L, Buyyounouski MK, Ma CCM, et al.: Dosimetric comparison of stereotactic body radiotherapy using 4D CT and multiphase CT images for treatment planning of lung cancer: evaluation of the impact on daily dose coverage. Radiother Oncol 2009, 91: 314-324. 10.1016/j.radonc.2008.11.018CrossRefPubMed

27.

Guckenberger M, Kavanagh A, Webbd S, Brada M: A novel respiratory motion compensation strategy combining gated beam delivery and mean target position concept – a compromise between small safety margins and long duty cycles. Radiother Oncol 2011, 98: 317-322. 10.1016/j.radonc.2011.01.008CrossRefPubMed

Title: Changes in volume of stage I non-small-cell lung cancer during stereotactic body radiotherapy
Authors: Kotoha Tatekawa
Hiromitsu Iwata
Takatsune Kawaguchi
Satoshi Ishikura
Fumiya Baba
Shinya Otsuka
Akifumi Miyakawa
Maho Iwana
Yuta Shibamoto
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-8

At a glance: The STEP trials

Springer Medicine

Changes in volume of stage I non-small-cell lung cancer during stereotactic body radiotherapy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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