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15.08.2017 | Original Article

Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

verfasst von: Susanne Temming, Prof. Dr. Martin Kocher, Erich Stoelben, Lars Hagmeyer, De-Hua Chang, Konrad Frank, Khosro Hekmat, Juergen Wolf, Wolfgang W. Baus, Robert Semrau, Christian Baues, S. Marnitz

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2018

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Abstract

Purpose

To evaluate efficacy and toxicity of stereotactic body radiation therapy (SBRT) with CyberKnife® (Accuray, Sunnyvale, CA, USA) in a selected cohort of primary, medically inoperable early-stage non-small cell lung cancer (NSCLC) patients.

Methods

From 2012 to 2016, 106 patients (median age 74 years, range 50–94 years) with primary NSCLC were treated with SBRT using CyberKnife®. Histologic confirmation was available in 87 patients (82%). For mediastinal staging, 92 patients (87%) underwent ¹⁸F-fluorodeoxyglucose positron-emission tomography (18-FDG-PET) and/or endobronchial ultrasound (EBUS)-guided lymph node biopsy or mediastinoscopy. Tumor stage (UICC8, 2017) was IA/B (T1a-c, 1–3 cm) in 86 patients (81%) and IIA (T2a/b, 3–5 cm) in 20 patients (19%). Depending on tumor localization, three different fractionation schedules were used: 3 fractions of 17Gy, 5 fractions of 11Gy, or 8 fractions of 7.5 Gy. Tracking was based on fiducial implants in 13 patients (12%) and on image guidance without markers in 88%.

Results

Median follow-up was 15 months (range 0.5–46 months). Acute side effects were mild (fatigue grade 1–2 in 20% and dyspnea grade 1–2 in 17%). Late effects were observed in 4 patients (4%): 3 patients developed pneumonitis requiring therapy (grade 2) and 1 patient suffered a rib fracture (grade 3). In total, 9/106 patients (8%) experienced a local recurrence, actuarial local control rates were 88% (95% confidence interval, CI, 80–96%) at 2 years and 77% (95%CI 56–98%) at 3 years. The median disease-free survival time was 27 months (95%CI 23–31 months). Overall survival was 77% (95%CI 65–85%) at 2 years and 56% (95%CI 39–73%) at 3 years.

Conclusion

CyberKnife® lung SBRT which allows for real-time tumor tracking and risk-adapted fractionation achieves satisfactory local control and low toxicity rates in inoperable early-stage primary lung cancer patients.

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Titel: Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer
verfasst von: Susanne Temming
Prof. Dr. Martin Kocher
Erich Stoelben
Lars Hagmeyer
De-Hua Chang
Konrad Frank
Khosro Hekmat
Juergen Wolf
Wolfgang W. Baus
Robert Semrau
Christian Baues
S. Marnitz
Publikationsdatum: 15.08.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1194-x

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Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer