Clinical outcome of stereotactic ablative radiotherapy with CyberKnife® for lung tumors: A single center experience

Year 2018, , 324 - 329, 01.09.2018

Ebru Atasever Akkaş , Ebru Karakaya Gonca Altınışık İnan Yasemin Güzle Adaş , Ömer Yazıcı Esra Kekilli , Ferhat Kıran Ferihan Ertan Bülent Küçükpilakçı Yıldız Güney

https://doi.org/10.28982/josam.432680

Abstract

Aim: To evaluate retrospectively clinical outcomes of treated with stereotactic ablative radiotherapy (SABR) using the CyberKnife® (Accuray, Sunnyvale, CA, USA), for early primary and oligometastatic lung tumors.

Methods: This descriptive study included thirty tumors from 29 patients with primary lung cancer (n=21) or oligometastatic lung tumors (n=9), who underwent SABR with robotic linear accelerator between March 2011 and July2015. Out of the 30 tumors, 21 were NSCLC, 9 were metastatic lung disease. Treatment was given using different tracking methods including fiducial tracking with Synchrony (21 patients) , Xsight lung with Synchrony (4 patients) and Xsight spine (5 patients). Treatment was delivered two to three fractions per week and with different fractionations depending on location and other tumor related factors. Factors, potentially effective on local control and overall survival were investigated.

Results: Median follow-up time for local control was 11 months (2.4-39 months). Of 25 patients with known follow-up data, local control (LC) rates for 1, 2 and 3 years were 82.8%, 82.8% and 55.2 %, respectively. Overall survival (OS) rates for primary lung tumor patients 1, 2 and 3 years were 72.2%, 64.2%, 51.4% and metastatic lung tumor patients for 1 year was 71%, respectively. Except for gender, none of the factors were statistically significantly associated with local control in univariate analysis; female gender was associated with worse local control (p=0.001). Also in univariate analysis of overall survival, there was a trend for worse survival in females, too (p=0.07). 

Conclusion: This small study may give some idea about utilizing different tracking ways for CyberKnife® with less toxicity. 

Keywords

Lung tumor, CyberKnife®, Stereotactic ablative radiotherapy

Akciğer tümörlerinde CyberKnife® ile stereotaktik ablatif radyoterapi sonuçlarımız: Tek merkez deneyimi

Abstract

Amaç: Primer ve oligometastatik akciğer karsinomu tanısıyla CyberKnife® (Accuray, Sunnyvale, CA, USA) kullanarak stereotaktik ablatif radyoterapi (SABR) ile tedavi edilen olgularımızın tedavi sonuçlarımızı değerlendirmek.

Yöntemler: Bu tanımlayıcı çalışmaya Mart 2011- Temmuz 2015 tarihleri arasında robotik lineer akselatör ile SABR tedavisi alan primer akciğer kanserli (n=21) ve oligometastatik akciğer tümörlü (n=9) 30 hastanın 29’u dahil edilmiştir. 30 tümörden 21'i KHDAK, 9'u metastatik akciğer hastalığı idi. Tüm tedavi adımları aynı doktor tarafından kontrol edildi. Tedavi, Synchrony (21 hasta), Synchrony ile Xsight akciğer (4 hasta) ve Xsight vertebra (5 hasta) ile fidusiyal izleme dahil olmak üzere farklı izleme yöntemleri kullanılarak verildi. Tedavi, lokal ve diğer tümörle ilişkili faktörlere bağlı olarak, haftada iki veya üç farklı fraksiyonlarda verildi. Lokal kontrol ve genel sağkalım üzerinde potansiyel olarak etkili faktörler araştırıldı.

Bulgular: Lokal kontrol için medyan takip süresi 11 ay (2,4-39 ay) idi. Bilinen takip verileri bulunan 25 hastanın 1, 2 ve 3 yıllık lokal kontrol (LC) oranları sırasıyla% 82,8, % 82,8 ve % 55,2 idi. Tüm sağkalım oranları primer akciğer tümörlü hastalar için 1,2 ve 3 yıllık sırasıyla %72,2, %64,2 ve %51,4 ve metastatik akciğer tümörleri için 1 yıllık %71 idi. Cinsiyet haricinde, tek değişkenli analizde faktörlerin hiçbiri lokal kontrol ile istatistiksel olarak anlamlı bir şekilde ilişkili değildi; kadın cinsiyeti daha kötü lokal kontrol ile ilişkiliydi (p=0.001). Ayrıca genel sağkalımın tek değişkenli analizinde, kadınlarda da daha kötü bir sağkalım eğilimi vardı (p=0.07).

Sonuç: Bu küçük çalışma, CyberKnife® için daha az toksisite ile farklı tedavi takip yöntemlerinin kullanımı hakkında biraz fikir verebilir.

Keywords

CyberKnife®, Akciğer tümörü, Stereotaktik ablatif radyoterapi

References

• 1. National Comprehensive Cancer Network. Non-Small Cell Lung Cancer (Version 3.2014) (2014). Availableform: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
• 2. Wu AJ, Williams E, Modh A, Foster A, Yorke E, Rimner A, et al. Dosimetric predictors of esophageal toxicity after stereotactic bodyradiotherapy for central lung tumors. Radiotherapy and Oncology. 2014;112:267-71.
• 3. Dosoretz DE, Katin MJ, Blitzer PH, Rubenstein JH, Galmarini DH, Garton GR, et al. Medically inoperable lung carcinoma: theroleofradiationtherapy. Semin Radiat Oncol. 1996;98-104.
• 4. Lagerwaard FJ, Haasbeek CJ, Smit EF, Slotman BJ, Senan S. Outcomes of risk adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008;70(3):685-92.
• 5. Hayashi S, Tanaka H, Kajiura Y, Ohno Y, Hoshi H. Stereotactic body radiotherapy for very elderly patients (age, greater than or equal to 85 years) with stage I non-small cell lung cancer. Radiat Oncol. 2014;9:138.
• 6. Louie AV, Rodrigues G, Hannouf M, Lagerwaard F, Palma D, Gregory S, et al. Withholding stereotactic radiotherapy in elderly patients with stage I nonsmall cell lung cancer and co-existing COPD is not justified: outcomes of a Markov model analysis. Radiother Oncol. 2011;99(2):161-5.
• 7. Shirvani SM, Jiang J, Chang JY, Welsh JW, Gomez DR, Swisher S, et al. Comparative effectiveness of 5 treatment Phys strategies for early-stage non-small cell lung cancer in the elderly. Int J Radiat Oncol Biol. 2012;84(5):1060-70.
• 8. Thibault I, Poon I, Yeung L, Erler D, Kim A, Keller B, et al. Predictive Factors for Local Control in Primary and Metastatic Lung Tumours after Four to Five Fraction Stereotactic Ablative Body Radiotherapy: A Single Institution’s Comprehensive Experience. Clinical Oncology. 2014;26:713-9.
• 9. Guo Y, Zhuang H, Zhao L, Yuan Z, Wang P. .Influence of different image-guided tracking methods upon the local efficacy of CyberKnife treatment in lung tumors. Thoracic Cancer. 2015;6:255-9.
• 10. Bibault JE, Prevost B, Dansin E, Mirabel X, Lacornerie T and Lartigau E. Image-Guided Robotic Stereotactic Radiation Therapy with Fiducial-Free Tumor Tracking for Lung Cancer. Radiation Oncology. 2012;7:102.
• 11. Jung IH, Song SY, Jung J, Cho B, Kwak J, Je HU et al. Clinical outcome of fiducial-less CyberKnife radiosurgery for stage I non-small cell lung cancer, Radiat Oncol J. 2015;33(2):89-97.
• 12. Radiation Therapy Oncology Group. RTOG 0236. A phase II trial of stereotactic body radiation therapy (SBRT) in the treatment of patients with medically inoperable stage I/II non-small cell lung cancer. [Internet] 2004 [updated 9 September 2009; cited 2 August2015].Availableat:https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx? study¼0236.
• 13. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of J. Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. Natl. Cancer Inst. 2000;92:205–16.
• 14. Collins BT, Vahdat S, Erickson K, Collins SP, Suy S, Yu X, et al. Radical cyberknife radiosurgery with tumor tracking: an effective treatment for inoperable small peripheral stage I non-small cell lung cancer. J Hematol Oncol. 2009;2:1.
• 15. Hoogeman M, Prevost JB, Nuyttens J, Pöll J, Levendag P, Heijmen B. Clinical accuracy of the respiratory tumor tracking system of the cyberknife: assessment by analysis of log files. Int J Radiat Oncol Biol Phys. 2009;74:297–303.
• 16. Prevost JB, Voet P, Hoogeman M, Praag J, Levendag P, Nuyttens JJ. Four-dimensional stereotactic radiotherapy for early stage non-small cell lung cancer: a comparative planning study. Technol Cancer Res Treat. 2008;7:27–33.
• 17. Derycke S, Van Duyse B, De Gersem W, De Wagter C, De Neve W. Non-coplanar beam intensity modulation allows large dose escalation in stage III lung cancer. Radiother Oncol. 1997;45:253–61.
• 18. Dong P, Lee P, Ruan D, Long T, Romeijn E, Low DA, et al. 4pi noncoplanar stereotactic body radiation therapy for centrally located or larger lung tumors. Int J Radiat Oncol Biol Phys. 2013;86:407–13.
• 19. Prevost JB, Nuyttens JJ, Hoogeman MS, Pöll JJ, van Dijk LC, Pattynama PMT, et al. Endovascular coils as lung tumour markers in real-time tumour tracking stereotactic radiotherapy: preliminary results. Eur Radiol. 2008;18:1569-76.
• 20. Bhagat N, Fidelman N, Durack JC, Collins J, Gordon RL, LaBerge JM, et al. Complications associated with the percutaneous insertion of fiducial markers in the thorax. Cardiovasc Intervent Radiol. 2010;33:1186-91.
• 21. Subedi G, Karasick T, Grimm J, Jain S, Xue J, Xu Q, et al. Factors that may determine the targeting accuracy of image-guided radiosurgery. Med Phys. 2015; 42(10):6004-10.
• 22. Collins BT, Erickson K, Reichner CA, Collins SP, Gagnon GJ, Dieterich S, et al. Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors. Radiat Oncol. 2007;2:39.
• 23. Jung J, Song SY, Yoon SM, Kwak J, Yoon K, Choi W, et al. Verification of accuracy of CyberKnife tumor-tracking radiation therapy using patient-specific lung phantoms. Int J Radiat Oncol Biol Phys 2015;92(4):745-53.
• 24. Factor OB, Vu CC, Schneider JG, Witten MR, Schubach SL, Gittleman AE, et al. Stereotactic body radiation therapy for stage I non-small cell lung cancer: a small academic hospital experience. Frontiers in Oncology. 2014;(4)287:2-5.
• 25. Shibamot Y, Hashizume C, Baba F, Ayakawa S, Manabe Y, Nagai A, et al. Stereotactic body radiotherapy using a radi obiology-based regimen for stage I non small cell lung cancer: a multicenter study. Cancer. 2012;118(8):2078–84.
• 26. Ohri N, Werner-Wasik M, Grills IS, Belderbos J, Hope A, Yan D, et al. Modeling local control after hypofractionated stereotactic body radiation therapy for stage I non-small cell lung cancer: a report from the elekta collaborative lung research group. Int J Radiat Oncol Biol Phys. 2012;84:379-84.
• 27. Matsuo Y, Shibuya K, Nagata Y, Takayama K, Norihisa Y, Mizowaki T, et al. Prognostic factors in stereotactic body radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;79:1104-11.
• 28. Wang Z, Kong QT, Li J, Wu XH, Li B, Shen ZT, et al. Clinical outcomes of cyberknife stereotactic radiosurgery for lung metastases. J Thorac Dis. 2015;7(3):407-12.
• 29. Crabtree TD, Puri V, Robinson C, Bradley J, Broderick S, Patterson GA, et al. Analysis of first recurrence and survival in patients with stageI non-smallcell lung cancer treated with surgical resection or stereotactic radiationtherapy. J Thorac Cardiovasc Surg. 2014;147(4):1183–91.
• 30. Timmerman R, Paulus R,Galvin J, Michalski J, Straube W, Bradley J, et al. Stereotactic body radiationtherapy for inoperable early stage lungcancer. JAMA. 2010;303(11):1070–6.
• 31. Fakiris AJ, McGarry RC, Yiannoutsos CT Papiez L, Williams M, Henderson MA, et al. 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(3):677–82.