Stereotactic Radiotherapy for Multiple Lung Metastases: Early Clinical Outcomes

Year 2022, Volume: 3 Issue: 2, 148 - 156, 01.08.2022

Fuzuli Tuğrul , Özcan Özden

Abstract

Introduction: Oligometastatic lung cancers are usually small in size and high doses of radiation increase the chance of local control. In this study, it was aimed to treat patients with stereotactic body radiotherapy (SBRT) technique and to examine the early effects of treatment in order to control these tumors of patients whose primary tumor was controlled but 3 and 4 metastases developed in their lungs. Methods: Computed tomography (CT) images of seven patients with three to four lung metastases were acquired using 2 mm sections. Treatment plans were prepared to deliver a total of 48 Gray (Gy) in four fractions at two isocenters. All plans were created using the Monaco treatment planning system (TPS) and the MonteCarlo algorithm at a filter-free 6MV energy (6FFF - dose rate: 1600 MU/min). During all these processes, the exact target was irradiated through active breathing control (ABC). Patients were administered a pulmonary function test (PFT) before and after the treatment and the results were compared. Results: 100% of the intended dose was prescribed to the tumor volumes of the patients. Critical organ doses met the TG101 standards. The maximum dose of the plans was kept below 120%. All treatment plans reached desired values and were clinically accepted. Conclusion: Local control was achieved in the patients and there was no grade 3-4-5 radiation pneumonia (RP). In particular, patients with severe pulmonary comorbidities should be carefully monitored for RP during the few months of follow-up after SBRT. Depending on the patient's condition (holding the breath, being stable, etc.) or the characteristics of the linear accelerator, SBRT can be safely administered to metastases at two or three isocenters and the metastases can be controlled when patients with locally controlled primary tumors develop multiple distant metastases in the lungs.

Keywords

Multiple lung metastases, SBRT, high MU, radiation pneumonia

Çoklu Akciğer Metastazları İçin Stereotaktik Radyoterapi: Erken Klinik Sonuçlar

Abstract

Giriş: Oligometastatik akciğer kanserleri genellikle küçük boyuttadır ve yüksek radyasyon ile lokal kontrol şansı artmaktadır. Bu çalışmada primer tümörü kontrol altına alınmış fakat akciğerlerinde 3 veya 4 metastaz gelişen hastaların bu tümörlerini kontrol altına almak için stereotaktik beden radyoterapi (SBRT) tekniği ile hastaların tedavi edilmesi ve tedavinin erken etkilerinin incelenmesi amaçlanmıştır. Yöntemler: Akciğerinde 3 ve 4 metastaz bulunan 7 hastanın tomografi (CT) görüntüleri 2mm kesitlerle çekildi. Tedavi planları iki izomerkezde 4 fraksiyondan toplamda 48 Gray (Gy) olacak şekilde hazırlandı. Bütün planlar Monaco tedavi planlama sistemi (TPS) ile MonteCarlo algoritması kullanılarak filtresiz 6MV enerjide (6FFF - doz hızı 1600MU/dk) oluşturuldu. Planlar hazırlanırken istenilen dozun %100’ü, tümör hacminin %100’üne reçete edilmesi amaçlandı. Hastalara tedavi öncesinde ve sonrasında solunum fonksyon testi (SFT) yapılarak sonuçları karşılaştırıldı. Bulgular: Tümör hacmine istenilen dozun %100’ü reçete edildi. Kritik organ dozları TG101 standartlarını karşıladı. Planların maksimum dozları 120%’nin altında tutuldu. Tüm tedavi planları istenilen dozları karşıladı ve klinik olarak kabul edilebilir durumdaydı. Sonuç: Hastalarda lokal kontrol sağlandı ve herhangi bir grade 3-4-5 radyasyon pnomonisi (RP) izlenmedi. Özellikle ciddi pulmoner komorbiditeleri olan hastalar, SBRT sonrası takip döneminde birkaç ay içinde RP'nin açısından dikkatle izlenmelidir. Hastanın durumuna (nefesini tutması, sabit kalabilmesi vb) veya lineer hızlandırıcının özelliklerine göre primer tümöründe lokal kontrol sağlanmış hastaların akciğerlerinde birbirine uzak birden fazla metastaz oluşması durumunda iki veya üç izomerkezle bu metastazlara güvenle SBRT tekniği uygulanabilir ve metastazların kontrolü sağlanabilir.

Keywords

Çoklu akciğer metastazları, SBRT, yüksek MU, radyasyon pnomonisi

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