Robotic Stereotactic Body Treatment for Early Stage non-Small Cell Lung Cancer

Yıl 2021, Cilt: 7 Sayı: 1, 43 - 53, 05.01.2021

Cemile Ceylan , Andaç Hamamcı , Hande Ayata , Kezban Berberoğlu , Özcan Gündoğdu , Kayıhan Engin

https://doi.org/10.30934/kusbed.760034

Öz

Objective: In this study, we retrospectively reviewed and statistically analyzed the Cyberknife SBRT outcomes in terms of local control and survival times for the patients with primer lung tumors treated at Anadolu Medical Center.
Methods: We included 135 patients who were treated between 2005 and 2016 and diagnosed primary lung cancer who were judged medically inoperable. median BED10 was 180 Gy (ranging 45-180). The treatment response was assessed using either a CT or a PET-CT scan or both. There were 108 men and 27 women, with an overall median age of 65 years (range 44-88 years). The median follow-up and overall survival were 19 (3-88) and 34 months, respectively.
Results: Overall survival and local control of the patients for 1, 2, 3, 5 years were 88%, 72%, 50%, 39%, and 81%, 54%, 51%, 39%, respectively. 1, 2 and 3 year survival rates for BED10=180Gy group were 89%, 84% and 72% respectively. 1, 2 and 3 year survival rates were found as 88%, 68% and 42% for BED<180Gy, respectively. 1, 2 and 3 year local control rates for BED=180Gy group were found as 92%, 86% and 86% respectively. 1, 2 and 3 year local control rates for BED<180Gy group were found as 78%, 42% and 38%. Local control and overall survival were associated with higher BED10. The difference between survival and local control of BED=180 Gy and BED<180 Gy are significant (p=0.008, p=0.002).
Conclusion: The Cyberknife stereotactic radiosurgery treatment with real-time tumor motion tracking is a promising well tolerated treatment option for inoperable early stage lung tumors.

Anahtar Kelimeler

SBRT, lung tumors, CyberKnife

Destekleyen Kurum

None

Proje Numarası

None

Erken Evre Küçük Hücreli Dışı Akciğer Kanserlerinin Tedavisinde Robotik Radyocerrahi

Öz

Amaç: Bu çalışmada Anadolu Sağlık Merkezi’nde robotik SBRT uygulanan erken evre akciğer kanserli olguların tedavi sonuçları geriye dönük olarak incelenip lokal kontrol ve sağkalım süreleri istatiksel olarak raporlanmaya çalışıldı.
Yöntem: Kliniğimizde 2005-2016 tarihleri arasında SBRT uygulanan opere edilemeyen ya da cerrahi istemeyen, T1-T2N0M0 evre 135 olgunun incelendi. 87 olgu Synchrony Takip yöntemi ile, 34 olgu X Sight Lung yöntemi ile tedavi edilirken 17 olgu X Sight Spine Takip yöntemi ile tedavi edildi. Medyan fraksiyon sayısı 3 (1-8) idi. Medyan BED10 değeri ise 180 Gy (45-180’ di. Tedaviye yanıt BT ve/veya PET/BT ile değerlendirildi. Medyan yaş değeri 65 (44-88) olan olguların 108’i erkek iken 27’si kadındı. Medyan takip süresi 19 (3-88), medyan sağkalım ise 34 ay hesaplandı.
Bulgular: Çalışmaya dahil edilen olgulara ait 1, 2, 3 ve 5 yıllık sağkalım %88, %72, %50 ve %39 iken aynı süreler için lokal kontrol ise %81, %54, %51 ve % 39 olarak elde edildi. BED=180 Gy ve BED<180 Gy olarak tedavi dozunun etkisi araştırıldığında dozun sağkalıma ve lokal kontrole etkisi anlamlı bulundu (p=0,002, p=0,008).
Sonuç: Gerçek zamanlı tümör hareket takibi ile Cyberknife stereotaktik radyocerrahi tedavisi, ameliyat edilemeyen erken evre akciğer olgularında umut verici ve tolere edilebilen bir tedavi seçeneğidir.

Anahtar Kelimeler

SBRT, akciğer kanseri, CyberKnife

Proje Numarası

None

Kaynakça

• Asamura H. Treatment of choice for stage I non-small cell lung cancer: surgery or radiotherapy? J Thorac Oncol 2006; 1:766-7. doı:https://doi.org/10.1016/S1556-0864(15)30403-2
• Chang MY, Sugarbaker DJ. Surgery for early stage non-small cell lung cancer. Semin Surg Oncol 2003 21: 74-84. doi: https://doi.org/10.1002/ssu.10024
• Scott WJ, Howington J, Feigenberg S, et al. Treatment of Non-small Cell Lung Cancer Stage I and Stage II. Chest 2007; 132; 234S-242S. doi: 10.1378/chest.07-1378
• Qiao X, Tullgren O, Lax I, et al. The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer 2003; 41(1):1–11 doi: 10.1016/s0169-5002(03)00152-1
• Baumann P, Nyman J, Hoyer M, et. al. Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol 2009; 27(20):3290–3296. doi: 10.1200/JCO.2008.21.5681.
• Grills IS, Hope AJ, Guckenberger M, et al. A collaborative analysis of stereotactic lung radiotherapy outcomes for early-stage non-small-cell lung cancer using daily online cone-beam computed tomography image-guided radiotherapy. J Thorac Oncol Of Publ Int Assoc Stud Lung Cancer 2012; 7(9):1382–1393. doi: 10.1097/JTO.0b013e318260e00d.
• Onishi H, Shirato H, Nagata Y, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol Of Publ Int Assoc Stud Lung Cancer 2012; 2(7 Suppl 3):94–100. doi: 10.1097/JTO.0b013e318074de34.
• Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 2010; 303(11):1070–1076. doi: 10.1001/jama.2010.261.
• Armstrong JG, Minsky BD. Radiation therapy for medically inoperable stage I and II non-small cell lung cancer. Cancer Treat Rev. 1989; 16(4):247-255. doi: 10.1016/0305-7372(89)90044-3.
• Jeremic B, Classen J, Bamber M. Radiotherapy alone in technically operable medically inoperable, early stage (I/II) non-small cell lung cancer. Int. J. Radiation Oncology Biol. Phys., 2002; 54:119-30. doi: 10.1016/s0360-3016(02)02917-6.
• Timmerman RD, Hu C, Michalski J, et al. Long-term Results of RTOG 0236: A Phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Patients with Medically Inoperable Stage I Non-Small Cell Lung Cancer. 2014 American Society for Radiation Oncology (ASTRO) 56th Annual Meeting.
• (NCCN) NCCN (2013) National comprehensive practice guidelines in oncology: non-small cell lung cancer. Natl Compr Netw 2:2013. doi: 10.6004/jnccn.2013.0084
• Kong FM, Ten Haken RK, Schipper MJ, et al. High-dose radiation improved local tumor control and overall survival in patients with inoparable/unresectable non-small cell lung cancer: long-term results of a radiaition dose escaltion study. Int J Radiat Oncol Biol Phys 2005; 63:324-33. doi: 10.1016/j.ijrobp.2005.02.010.
• Zhang J, Yang F, Li B, et al. Which is the optimal biologically effective dose of stereotactic body radiotherapy for Stage I non-small-cell lung cancer? A meta-analysis. Int J Radiat Oncol Biol Phys. 2011; 15; 81(4):e305-16. doi: 10.1016/j.ijrobp.2011.04.034.
• Joanne ND, Clinton M, Sanjeev S, et al. Stereotactic body radiotherapy for early-stage non-small cell lung cancer: clinical outcomes from a National Patient Registry. J Radiat Oncol. 2015; 4(1):55–63. doi: 10.1007/s13566-014-0177-0.
• Potters L, Steinberg M, Rose C, et al. American Society for Therapeutic Radiology and Oncology and American College of Radiology Practice Guideline for The Performance of Stereotactic Body Radiation Therapy. Int. J. Radiation Oncology Biol. Phys., 2004; 60, 4: 1026–1032. doi: 10.1016/j.ijrobp.2004.07.701.
• Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy: The report of AAPM Task Group 101. Medical Physics, 2010; 37, 8: 4078-4101. doi: 10.1118/1.3438081.
• William TB, Xiaodong W, Fahed F, et al. Cyberknife Radiosurgery for Stage I Lung Cancer: Results at 36 Months. Clinical Lung Cancer 2007; 8:8:488-492. doi: 10.3816/CLC.2007.n.033.
• Whyte RI, Crownover R, Murphy MJ, et al. Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial. Ann Thorac Surg 2003; 75:1097-1101. doi: 10.1016/s0003-4975(02)04681-7.
• Singh AK, Gomez-Suescun JA, Stephans KL, et al. One versus Three Fractions of Stereotactic Body Radiation Therapy for Peripheral Stage I to II Non-Small Cell Lung Cancer: A Randomized, Multi-Institution, Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2019; 105(4):752-759. doi:10.1016/j.ijrobp.2019.08.019.
• Kimura T, Nagata Y, Harada H, Hayashi S, Matsuo Y, Takanaka T, Kokubo M, Takayama K, Onishi H, Hirakawa K, Shioyama Y, Ehara T. Phase I study of stereotactic body radiation therapy for centrally located stage IA non-small cell lung cancer (JROSG10-1). Int J Clin Oncol. 2017 Oct;22(5):849-856. doi: 10.1007/s10147-017-1125-y. Epub 2017 May 2. PMID: 28466183..
• Tandberg DJ, Tong BC, Ackerson BG, et al. Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer: A comprehensive review. Cancer. 2018; 124(4):667-678. doi:10.1002/cncr.31196.
• RTOG 0813 Seamless Phase I/II Study of Stereotactic Lung Radiotherapy (SBRT) for Early Stage, Centrally Located, Non-Small Cell Lung Cancer (NSCLC) in Medically Inoperable Patients. 2015.
• Timmerman R, Papiez L, McGarry R, et al. Extracranial Stereotactic Radioablation: Results of Phase I Study in Medically Inoperable Stage I Non-small Cell Lung Cancer. Chest 200; 124:5:1946-1955. doi: 10.1378/chest.124.5.1946.
• Karaman K, Dokdok M, Karadeniz O, et al. Intravascular Placement of Metallic Coils as Lung Tumor Markers for CyberKnife Stereotactic Radiation Therapy, Korean J Radiol 2015;16(3):626-631. doi: 10.3348/kjr.2015.16.3.626
• CTCAE (National Cancer Institute Common Terminology Criteria for Adverse Events, v4.0.
• Paddick I: A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg. 2000, 93 Suppl 3:219-222. doi: 10.3171/jns.2000.93.supplement.
• Nakamura JL, Verhey LJ, Smith V, et al. Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys 2001, 51(5):1313-1319. doi: 10.1016/s0360-3016(01)01757-6.
• Brown WT, Wu X, Fayad F, et al. Application of robotic stereotactic radiotherapy to peripheral stage I non-small cell lung cancer with curative intent. Clin Oncol 2009;21, 623-631 doi: 10.1016/j.clon.2009.06.006.
• Rusthoven CG, Jones BL, Kavanagh BD. Medical operability, and inoperability drive survival in retrospective analyses comparing surgery and SBRT for early-stage lung cancer. J Thorac Cardiovasc Surg. 2018; 155(2):810-811. doi:10.1016/j.jtcvs .2017.09.087.
• Videtic GM, Paulus R, Singh AK, et al. Long-term Follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): 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. Int J Radiat Oncol Biol Phys. 2019; 103(5):1077-1084. doi:10.1016/j.ijrobp.2018.11.051.
• Fakiris AJ, McGarry RC, Yiannoutsos CT, 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; 75:677–82 doi: 10.1016/j.ijrobp.2008.11.042.
• Whyte RI, Crownover R, Murphy MJ, et al. Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial. Ann Thorac Surg 2003; 75,1097-1101. doi: 10.1016/s0003-4975(02)04681-7.
• Kelley KD, Benninghoff DL, Stein JS, et al. Medically inoperable peripheral lung cancer treated with stereotactic body radiation therapy. Radiation Oncology 2015;10:120 doi: 10.1186/s13014-015-0423-7.
• Collins BT, Vahdat S, Erickson K, 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; 17;2:1. doi: 10.1186/1756-8722-2-1
• van der Voort van Zyp NC, Prévost JB, Hoogeman MS, et al. Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: clinical outcome. Radiother Oncol. 2009 Jun;91(3):296-3. doı: 10.1016/j.radonc.2009.02.011
• Katoh N, Soda I, Tamamura H, et al. Clinical outcomes of stage I and IIA nonsmall cell lung cancer patients treated with stereotactic body radiotherapy using a realtime tumor-tracking radiotherapy system. Radiation Oncology 2017;12:3. doı: 10.1186/s13014-016-0742-3
• Sharma SC, Ott JT, Williams JB, et al. Clinical implications of adopting Monte Carlo treatment planning for CyberKnife. J App Clin Med Phys 2010; 11,3142 doi: 10.1120/jacmp.v11i1.3142.
• Wilcox EE, Daskalov GM, Lincoln H, et al. Comparison of planned dose distributions calculated by Monte Carlo and Ray-Trace algorithms for the treatment of lung tumors with CyberKnife: a preliminary study in 33 patients. Int J Radiat Oncol Biol Phys 2010; 77, 277-284. doi: 10.1016/j.ijrobp.2009.08.001.