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

Tumori. Jan-Feb 2014;100(1):42-8. doi: 10.1700/1430.15814.

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 18F-fluorodeoxyglucose (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 mid-fraction 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.

MeSH terms

  • Adenocarcinoma / radiotherapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Carcinoma, Squamous Cell / radiotherapy
  • Dose Fractionation, Radiation
  • Female
  • Fluorodeoxyglucose F18
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Louisiana
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Positron-Emission Tomography / methods
  • Radiopharmaceuticals
  • Radiosurgery / adverse effects
  • Radiosurgery / methods*
  • Radiotherapy, Image-Guided*
  • Tomography, Spiral Computed*
  • Treatment Outcome

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18