Stereotactic Ablative Radiation Therapy for Centrally Located Early Stage or Isolated Parenchymal Recurrences of Non-Small Cell Lung Cancer: How to Fly in a 'No Fly Zone'
| Autor: | Peter A Balter, Pamela K. Allen, Daniel R. Gomez, Neal Rebueno, Reza J. Mehran, Qing Yong Xu, Joe Y. Chang, Stephen G. Swisher, Qiao Qiao Li, Ritsuko Komaki, Jack A. Roth |
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| Rok vydání: | 2014 |
| Předmět: |
Cancer Research
medicine.medical_specialty Radiation Lung business.industry medicine.medical_treatment medicine.disease Radiation therapy medicine.anatomical_structure Oncology Carcinoma medicine Radiology Nuclear Medicine and imaging Radiology Esophagus Stage (cooking) Lung cancer business Brachial plexus Pneumonitis |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 88:1120-1128 |
| ISSN: | 0360-3016 |
| Popis: | Purpose We extended our previous experience with stereotactic ablative radiation therapy (SABR; 50 Gy in 4 fractions) for centrally located non-small cell lung cancer (NSCLC); explored the use of 70 Gy in 10 fractions for cases in which dose-volume constraints could not be met with the previous regimen; and suggested modified dose-volume constraints. Methods and Materials Four-dimensional computed tomography (4DCT)-based volumetric image-guided SABR was used for 100 patients with biopsy-proven, central T1-T2N0M0 (n=81) or isolated parenchymal recurrence of NSCLC (n=19). All disease was staged with positron emission tomography/CT; all tumors were within 2 cm of the bronchial tree, trachea, major vessels, esophagus, heart, pericardium, brachial plexus, or vertebral body. Endpoints were toxicity, overall survival (OS), local and regional control, and distant metastasis. Results At a median follow-up time of 30.6 months, median OS time was 55.6 months, and the 3-year OS rate was 70.5%. Three-year cumulative actuarial local, regional, and distant control rates were 96.5%, 87.9%, and 77.2%, respectively. The most common toxicities were chest-wall pain (18% grade 1, 13% grade 2) and radiation pneumonitis (11% grade 2 and 1% grade 3). No patient experienced grade 4 or 5 toxicity. Among the 82 patients receiving 50 Gy in 4 fractions, multivariate analyses showed mean total lung dose >6 Gy, V 20 >12%, or ipsilateral lung V 30 >15% to independently predict radiation pneumonitis; and 3 of 9 patients with brachial plexus D max >35 Gy experienced brachial neuropathy versus none of 73 patients with brachial D max P =.001). Other toxicities were analyzed and new dose-volume constraints are proposed. Conclusions SABR for centrally located lesions produces clinical outcomes similar to those for peripheral lesions when normal tissue constraints are respected. |
| Databáze: | OpenAIRE |
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