Top

Published in:

Open Access 01-12-2010 | Research

Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size

Authors: Fumiya Baba, Yuta Shibamoto, Hiroyuki Ogino, Rumi Murata, Chikao Sugie, Hiromitsu Iwata, Shinya Otsuka, Katsura Kosaki, Aiko Nagai, Taro Murai, Akifumi Miyakawa

Published in: Radiation Oncology | Issue 1/2010

Abstract

Background

The treatment schedules for stereotactic body radiotherapy (SBRT) for lung cancer vary from institution to institution. Several reports have indicated that stage IB patients had worse outcomes than stage IA patients when the same dose was used. We evaluated the clinical outcomes of SBRT for stage I non-small cell lung cancer (NSCLC) treated with different doses depending on tumor diameter.

Methods

Between February 2004 and November 2008, 124 patients with stage I NSCLC underwent SBRT. Total doses of 44, 48, and 52 Gy were administered for tumors with a longest diameter of less than 1.5 cm, 1.5-3 cm, and larger than 3 cm, respectively. All doses were given in 4 fractions.

Results

For all 124 patients, overall survival was 71%, cause-specific survival was 87%, progression-free survival was 60%, and local control was 80%, at 3 years. The 3-year overall survival was 79% for 85 stage IA patients treated with 48 Gy and 56% for 37 stage IB patients treated with 52 Gy (p = 0.05). At 3 years, cause-specific survival was 91% for the former group and 79% for the latter (p = 0.18), and progression-free survival was 62% versus 54% (p = 0.30). The 3-year local control rate was 81% versus 74% (p = 0.35). The cumulative incidence of grade 2 or 3 radiation pneumonitis was 11% in stage IA patients and 30% in stage IB patients (p = 0.02).

Conclusions

There was no difference in local control between stage IA and IB tumors despite the difference in tumor size. The benefit of increasing the SBRT dose for larger tumors should be investigated further.

Available only for authorised users

Uematsu M, Shioda A, Suda A, Fukui T, Ozeki Y, Hama Y, Wong JR, Kusano S: Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small-cell lung cancer: a 5-year experience. Int J Radiat Oncol Biol Phys 2001, 51: 666-670.CrossRefPubMed

Nagata Y, Takayama K, Matsuo Y, Norihisa Y, MIzowaki T, Sakamoto T, Sakamoto M, Mitsumori M, Shibuya K, Araki N, Yano S, HIraoka M: Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2005, 63: 1427-1431. 10.1016/j.ijrobp.2005.05.034CrossRefPubMed

Onimaru R, Fujino M, Yamazaki K, Onodera Y, Taguchi H, Katoh N, Hommura F, Oizumi S, Nishimura M, Shirato H: Steep dose-response relationship for stage I non-small-cell lung cancer using hypofractionated high-dose irradiation by real-time tumor-tracking radiotherapy. Int J Radiat Oncol Biol Phys 2009, 70: 374-381.CrossRef

Koto M, Takai Y, Ogawa Y, Matsushita H, Kateda K, Takahashi C, Britton KR, Jingu K, Takai K, Mitsuya M, Nemoto K, Yamada S: 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

Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G, Lax I, Drugge N, Ekberg L, Friesland S, Johansson KA, Lund JA, Morhed E, Nilsson K, Levin N, Paludan M, Sederholm C, Traberg A, Wittgren L, Lewensohn R: Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol 2009, 27: 3290-3296. 10.1200/JCO.2008.21.5681CrossRefPubMed

Takeda A, Sanuki N, Kunieda E, Ohashi T, Oku Y, Takeda T, Shigematsu N, Kubo A: Stereotactic body radiotherapy for primary lung cancer at a dose of 50 Gy total in five fractions to the periphery of the planning target volume calculated using a superposition algorithm. Int J Radiat Oncol Biol Phys 2009, 73: 442-448.CrossRefPubMed

Fakiris AJ, McGarry RC, Yiannoutsos CT, Papiez L, Williams M, Henderson MA, Timmerman R: Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys 2009, 75: 677-682.CrossRefPubMed

Norihisa Y, Nagata Y, Takayama K, Matsuo Y, Sakamoto T, Sakamoto M, Mizowaki T, Yano S, Hiraoka M: Stereotactic body radiotherapy for oligometastatic lung tumors. Int J Radiat Oncol Biol Phys 2008, 72: 398-403.CrossRefPubMed

Rusthoven KE, Kavanagh BD, Burri SH, Chen C, Cardenes H, Chidel MA, Pugh TJ, Kane M, Gaspar LE, Schefter TE: Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. J Clin Oncol 2009, 27: 1579-1584. 10.1200/JCO.2008.19.6386CrossRefPubMed

10.

Nagata Y, Hiraoka M, Mizowaki T, Narita Y, Matsuo Y, Norihisa Y, Onishi H, Shirato H: Survey of stereotactic body radiation therapy in Japan by the Japan 3-D conformal external beam radiotherapy group. Int J Radiat Oncol Biol Phys 2009, 75: 343-347.CrossRefPubMed

11.

Baba F, Shibamoto Y, Tomita N, Ikeya-Hashizume C, Oda K, Ayakawa S, Ogino H, Sugie C: Stereotactic body radiotherapy for stage I lung cancer and small lung metastasis: evaluation of an immobilization system for suppression of respiratory tumor movement and preliminary results. Radiat Oncol 2009., 4: article 15 10.1186/1748-717X-4-15

12.

Iwata H, Shibamoto Y, Murata R, Tomita N, Ayakawa S, Ogino H, Ito M: Estimation of errors associated with use of linear-quadratic formalism for evaluation of biologic equivalence between single and hypofractionated radiation doses: an in vitro study. Int J Radiat Oncol Biol Phys 2009, 75: 482-488.CrossRefPubMed

13.

Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, Ewing M, Abdulrahman R, DesRosiers C, Williams M, Fletcher J: Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006, 24: 4833-4839. 10.1200/JCO.2006.07.5937CrossRefPubMed

14.

Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T, Takeda A, Ouchi A, Hareyama M, Kokubo M, Hara R, Itami J, Yamada K, Araki T: Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2007,2(Suppl 3):S94-100. 10.1097/JTO.0b013e318074de34CrossRefPubMed

15.

Willner J, Baier K, Caragiani E, Tschammler A, Flentje M: Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002, 52: 382-389.CrossRefPubMed

16.

Qiao X, Tullgren O, Lax I, Sirzén F, Lewensohn R: The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer 2003, 41: 1-11. 10.1016/S0169-5002(03)00152-1CrossRefPubMed

17.

Shibamoto Y, Yukawa Y, Tsutsui K, Takahashi M, Abe M: Variation in the hypoxic fraction among mouse tumors of different types, sizes, and sites. Jpn J Cancer Res 1986, 77: 908-915.PubMed

18.

Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, Fakiris A, Bezjak A, Videtic G, Johnstone D, Fowler J, Gore E, Choy H: Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 2010, 303: 1070-1076. 10.1001/jama.2010.261PubMedCentralCrossRefPubMed

19.

Guckenberger M, Wulf J, Mueller G, Krieger T, Baier K, Gabor M, Richter A, Wilbert J, Flentje M: Dose-response relationship for image-guided stereotactic body radiotherapy of pulmonary tumors: relevance of 4D dose calculation. Int J Radiat Oncol Biol Phys 2009, 74: 47-54.CrossRefPubMed

20.

Haedinger U, Krieger T, Flentje M, Wulf J: Influence of calculation model on dose distribution in stereotactic radiotherapy for pulmonary targets. Int J Radiat Oncol Biol Phys 2005, 61: 239-249.CrossRefPubMed

21.

Takeda A, Kunieda E, Sanuki N, Ohashi T, Oku Y, Sudo Y, Iwashita H, Ooka Y, Aoki Y, Shigematsu N, Kubo A: Dose distribution analysis in stereotactic body radiotherapy using dynamic conformal multiple arc therapy. Int J Radiat Oncol Biol Phys 2009, 74: 363-369.CrossRefPubMed

22.

Borst GR, Ishikawa M, Nijkamp J, Hauptmann M, Shirato H, Onimaru R, van den Heuvel MM, Belderbos J, Lebesque JV, Sonke JJ: Radiation pneumonitis in patients treated for malignant pulmonary lesions with hypofractionated radiation therapy. Radiother Oncol 2009, 91: 307-313. 10.1016/j.radonc.2009.02.003CrossRefPubMed

23.

Guckenberger M, Baier K, Polat B, Richter A, Krieger T, Wilbert J, Mueller G, Flentje M: Dose-response relationship for radiation-induced pneumonitis after pulmonary stereotactic body radiotherapy. Radiother Oncol 2010. 10.1016/j.radonc.2010.04.027

24.

Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA, Perez CA: Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999, 45: 323-329.CrossRefPubMed

25.

Kwa SL, Lebesque JV, Theuws JC, Marks LB, Munley MT, Bentel G, Oetzel D, Spahn U, Graham MV, Drzymala RE, Purdy JA, Lichter AS, Martel MK, Ten Haken RK: Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998, 42: 1-9.CrossRefPubMed

26.

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

27.

Chen Y, Guo W, Lu Y, Zou B: Dose-individualized stereotactic body radiotherapy for T1-3N0 non-small cell lung cancer: long-term results and efficacy of adjuvant chemotherapy. Radiother Oncol 2008, 88: 351-358. 10.1016/j.radonc.2008.07.013CrossRefPubMed

Title: Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size
Authors: Fumiya Baba
Yuta Shibamoto
Hiroyuki Ogino
Rumi Murata
Chikao Sugie
Hiromitsu Iwata
Shinya Otsuka
Katsura Kosaki
Aiko Nagai
Taro Murai
Akifumi Miyakawa
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2010
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-5-81

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

Proposing the lymphatic target volume for elective radiation therapy for pancreatic cancer: a pooled analysis of clinical evidence

Fractionated stereotactic radiotherapy for skull base tumors: analysis of treatment accuracy using a stereotactic mask fixation system

Treatment planning using MRI data: an analysis of the dose calculation accuracy for different treatment regions

Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

Semi-robotic 6 degree of freedom positioning for intracranial high precision radiotherapy; first phantom and clinical results

A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer