Top

Published in:

01-02-2018 | Original Article

Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

Authors: Susanne Temming, Prof. Dr. Martin Kocher, Erich Stoelben, Lars Hagmeyer, De-Hua Chang, Konrad Frank, Khosro Hekmat, Juergen Wolf, Wolfgang W. Baus, Robert Semrau, Christian Baues, S. Marnitz

Published in: Strahlentherapie und Onkologie | Issue 2/2018

Abstract

Purpose

To evaluate efficacy and toxicity of stereotactic body radiation therapy (SBRT) with CyberKnife® (Accuray, Sunnyvale, CA, USA) in a selected cohort of primary, medically inoperable early-stage non-small cell lung cancer (NSCLC) patients.

Methods

From 2012 to 2016, 106 patients (median age 74 years, range 50–94 years) with primary NSCLC were treated with SBRT using CyberKnife®. Histologic confirmation was available in 87 patients (82%). For mediastinal staging, 92 patients (87%) underwent ¹⁸F-fluorodeoxyglucose positron-emission tomography (18-FDG-PET) and/or endobronchial ultrasound (EBUS)-guided lymph node biopsy or mediastinoscopy. Tumor stage (UICC8, 2017) was IA/B (T1a-c, 1–3 cm) in 86 patients (81%) and IIA (T2a/b, 3–5 cm) in 20 patients (19%). Depending on tumor localization, three different fractionation schedules were used: 3 fractions of 17Gy, 5 fractions of 11Gy, or 8 fractions of 7.5 Gy. Tracking was based on fiducial implants in 13 patients (12%) and on image guidance without markers in 88%.

Results

Median follow-up was 15 months (range 0.5–46 months). Acute side effects were mild (fatigue grade 1–2 in 20% and dyspnea grade 1–2 in 17%). Late effects were observed in 4 patients (4%): 3 patients developed pneumonitis requiring therapy (grade 2) and 1 patient suffered a rib fracture (grade 3). In total, 9/106 patients (8%) experienced a local recurrence, actuarial local control rates were 88% (95% confidence interval, CI, 80–96%) at 2 years and 77% (95%CI 56–98%) at 3 years. The median disease-free survival time was 27 months (95%CI 23–31 months). Overall survival was 77% (95%CI 65–85%) at 2 years and 56% (95%CI 39–73%) at 3 years.

Conclusion

CyberKnife® lung SBRT which allows for real-time tumor tracking and risk-adapted fractionation achieves satisfactory local control and low toxicity rates in inoperable early-stage primary lung cancer patients.

Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, Groen HJ, McRae SE, Widder J, Feng L et al (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 16:630–637CrossRefPubMedPubMedCentral

Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman B, Senan S (2011) Treatment of stage I NSCLC in elderly patients: a population-based matched-pair comparison of stereotactic radiotherapy versus surgery. Radiother Oncol 101:240–244CrossRefPubMed

Guckenberger M, Andratschke N, Alheit H, Holy R, Moustakis C, Nestle U, Sauer O (2014) Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol 190:26–33CrossRefPubMed

Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S (2010) Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol 28:5153–5159CrossRefPubMed

Palma DA, Senan S (2013) Improving outcomes for high-risk patients with early-stage non-small-cell lung cancer: insights from population-based data and the role of stereotactic ablative radiotherapy. Clin Lung Cancer 14:1–5CrossRefPubMed

Chang JY, Cox JD (2010) Improving radiation conformality in the treatment of non-small cell lung cancer. Semin Radiat Oncol 20:171–177CrossRefPubMedPubMedCentral

Nuyttens JJ, van de Pol M (2012) The CyberKnife radiosurgery system for lung cancer. Expert Rev Med Devices 9:465–475CrossRefPubMed

Lagerwaard FJ, Verstegen NE, Haasbeek CJ, Slotman BJ, Paul MA, Smit EF, Senan S (2012) Outcomes of stereotactic ablative radiotherapy in patients with potentially operable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 83:348–353CrossRefPubMed

Colinet B, Jacot W, Bertrand D, Lacombe S, Bozonnat MC, Daures JP, Pujol JL (2005) A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson’s index. Br J Cancer 93:1098–1105CrossRefPubMedPubMedCentral

10.

Pasic A, Brokx HA, Comans EF, Herder GJ, Risse EK, Hoekstra OS, Postmus PE, Sutedja TG (2005) Detection and staging of preinvasive lesions and occult lung cancer in the central airways with 18 F-fluorodeoxyglucose positron emission tomography: a pilot study. Clin Cancer Res 11:6186–6189CrossRefPubMed

11.

Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G, Rice T, Suzuki K, Thomas CF Jr., Travis WD et al (2015) The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol 10:990–1003CrossRefPubMed

12.

Chan MK, Werner R, Ayadi M, Blanck O (2015) Comparison of 3D and 4D Monte Carlo optimization in robotic tracking stereotactic body radiotherapy of lung cancer. Strahlenther Onkol 191:161–171CrossRefPubMed

13.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMed

14.

Essler M, Wantke J, Mayer B, Scheidhauer K, Bundschuh RA, Haller B, Astner ST, Molls M, Andratschke N (2013) Positron-emission tomography CT to identify local recurrence in stage I lung cancer patients 1 year after stereotactic body radiation therapy. Strahlenther Onkol 189:495–501CrossRefPubMed

15.

Falkson CB, Vella ET, Yu E, El-Mallah M, Mackenzie R, Ellis PM, Ung YC (2017) Radiotherapy With Curative Intent in Patients With Early-stage, Medically Inoperable, Non-Small-cell Lung Cancer: A Systematic Review. Clin Lung Cancer. doi:10.1016/j.cllc.2016.10.008 PubMed

16.

Guckenberger M, Allgauer M, Appold S, Dieckmann K, Ernst I, Ganswindt U, Holy R, Nestle U, Nevinny-Stickel M, Semrau S et al (2013) Safety and efficacy of stereotactic body radiotherapy for stage 1 non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis. J Thorac Oncol 8:1050–1058CrossRefPubMed

17.

Kishan AU, Lee P (2016) Radiation therapy for stage I nonoperable or medically inoperable lung cancer. Semin Respir Crit Care Med 37:716–726CrossRefPubMed

18.

Murray P, Franks K, Hanna GG (2017) A systematic review of outcomes following Stereotactic Ablative Radiotherapy in the treatment of early stage primary lung cancer. Br J Radiol. doi:10.1259/bjr.20160732 PubMedCentral

19.

Bahig H, Filion E, Vu T, Roberge D, Lambert L, Bouchard M, Lavoie C, Doucet R, Nadeau DB, Chalaoui J et al (2015) Excellent cancer outcomes following patient-adapted Robotic lung SBRT but a case for caution in idiopathic pulmonary fibrosis. Technol Cancer Res Treat 14:667–676CrossRefPubMed

20.

Bibault JE, Prevost B, Dansin E, Mirabel X, Lacornerie T, Lartigau E (2012) Image-guided robotic stereotactic radiation therapy with fiducial-free tumor tracking for lung cancer. Radiat Oncol 7:102CrossRefPubMedPubMedCentral

21.

Factor OB, Vu CC, Schneider JG, Witten MR, Schubach SL, Gittleman AE, Catell DT, Haas JA (2014) Stereotactic body radiation therapy for stage I non-small cell lung cancer: a small academic hospital experience. Front Oncol 4:287CrossRefPubMedPubMedCentral

22.

Heal C, Ding W, Lamond J, Wong M, Lanciano R, Su S, Yang J, Feng J, Arrigo S, Markiewicz D et al (2015) Definitive treatment of early-stage non-small cell lung cancer with stereotactic ablative body radiotherapy in a community cancer center setting. Front Oncol 5:146CrossRefPubMedPubMedCentral

23.

Kelley KD, Benninghoff DL, Stein JS, Li JZ, Byrnes RT, Potters L, Knisely JP, Zinkin HD (2015) Medically inoperable peripheral lung cancer treated with stereotactic body radiation therapy. Radiat Oncol 10:120CrossRefPubMedPubMedCentral

24.

van der Voort van Zyp NC, Prevost JB, Hoogeman MS, Praag J, van der Holt B, Levendag PC, van Klaveren RJ, Pattynama P, Nuyttens JJ (2009) Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: clinical outcome. Radiother Oncol 91:296–300CrossRefPubMed

25.

Guckenberger M (2015) Dose and fractionation in stereotactic body radiation therapy for stage I non-small cell lung cancer: lessons learned and where do we go next? Int J Radiat Oncol Biol Phys 93:765–768CrossRefPubMed

26.

Guckenberger M, Klement RJ, Allgauer M, Andratschke N, Blanck O, Boda-Heggemann J, Dieckmann K, Duma M, Ernst I, Ganswindt U et al (2016) Local tumor control probability modeling of primary and secondary lung tumors in stereotactic body radiotherapy. Radiother Oncol 118:485–491CrossRefPubMed

27.

Guckenberger M, Klement RJ, Allgauer M, Appold S, Dieckmann K, Ernst I, Ganswindt U, Holy R, Nestle U, Nevinny-Stickel M et al (2013) Applicability of the linear-quadratic formalism for modeling local tumor control probability in high dose per fraction stereotactic body radiotherapy for early stage non-small cell lung cancer. Radiother Oncol 109:13–20CrossRefPubMed

28.

Nyman J, Hallqvist A, Lund JA, Brustugun OT, Bergman B, Bergstrom P, Friesland S, Lewensohn R, Holmberg E, Lax I (2016) SPACE – A randomized study of SBRT vs conventional fractionated radiotherapy in medically inoperable stage I NSCLC. Radiother Oncol 121:1–8CrossRefPubMed

29.

Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, Fakiris A, Bezjak A, Videtic G, Johnstone D et al (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303:1070–1076CrossRefPubMedPubMedCentral

30.

Videtic GM, Hu C, Singh AK, Chang JY, Parker W, Olivier KR, Schild SE, Komaki R, Urbanic JJ, Timmerman RD et al (2015) A randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer: NRG oncology RTOG 0915 (NCCTG N0927). Int J Radiat Oncol Biol Phys 93:757–764CrossRefPubMedPubMedCentral

31.

Patel Z, Retrouvey M, Vingan H, Williams S (2014) Tumor track seeding: a new complication of fiducial marker insertion. Radiol Case Rep 9:928CrossRefPubMed

32.

Mendiratta-Lala M, Sheiman R, Brook OR, Gourtsoyianni S, Mahadevan A, Siewert B (2014) CT-guided core biopsy and percutaneous fiducial seed placement in the lung: can these procedures be combined without an increase in complication rate or decrease in technical success? Eur J Radiol 83:720–725CrossRefPubMed

Title: Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer
Authors: Susanne Temming
Prof. Dr. Martin Kocher
Erich Stoelben
Lars Hagmeyer
De-Hua Chang
Konrad Frank
Khosro Hekmat
Juergen Wolf
Wolfgang W. Baus
Robert Semrau
Christian Baues
S. Marnitz
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 2/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1194-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

Outcome and prognostic factors in single brain metastases from small-cell lung cancer

Radiotherapy for extramedullary leukaemic manifestation (Chloroma)

Perioperative chemotherapy vs. neoadjuvant chemoradiation in gastroesophageal junction adenocarcinoma

Radiation-induced liver injury mimicking liver metastases on FDG-PET-CT after chemoradiotherapy for esophageal cancer

Frühe Mitbetreuung nichtheilbarer Krebspatienten durch Palliativteams bessert die Lebensqualität und fördert Gespräche über Versorgungswünsche am Lebensende

Neoadjuvant versus definitive chemoradiotherapy for locally advanced esophageal cancer