Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial

doi:10.1016/S0003-4975(02)04681-7

The Annals of Thoracic Surgery

Volume 75, Issue 4, April 2003, Pages 1097-1101

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

https://doi.org/10.1016/S0003-4975(02)04681-7 Get rights and content

Abstract

Background

Stereotactic radiosurgery is well established for the treatment of intracranial neoplasms but its use for lung tumors is novel.

Methods

Twenty-three patients with biopsy-proven lung tumors were recruited into a two-institution, dose-escalation, phase I clinical trial using a frameless stereotactic radiosurgery system (CyberKnife). Fifteen patients had primary lung tumors and 8 had metastatic tumors. The age range was 23 to 87 years (mean, 63 years). After undergoing computed tomography–guided percutaneous placement of two to four small metal fiducials directly into the tumor, patients received 1,500 cGY of radiation in a single fraction using a linear accelerator mounted on a computer-controlled robotic arm. Safety, feasibility, and efficacy were studied.

Results

Nine patients were treated with a breath-holding technique, and 14 with a respiratory-gating, automated, robotic technique. Tumor size ranged from 1 to 5 cm in maximal diameter. There were four complications related to fiducial placement: three pneumothoraces requiring chest tube insertion and one emphysema exacerbation. There were no grade 3 to 5 radiation-related complications. Follow-up ranged from 1 to 26 months (mean, 7.0 months). Radiographic response was scored as complete in 2 patients, partial in 15, stable in 4, and progressive in 2. Four patients died of non–treatment-related causes at 1, 5, 9, and 11 months after radiation.

Conclusions

Single-fraction stereotactic radiosurgery is safe and feasible for the treatment of selected lung tumors. Additional studies are planned to investigate the optimal radiation dose, best motion-suppression technique, and overall treatment efficacy.

Section snippets

Patients and methods

The CyberKnife radiosurgery system (Fig 1) involves a 6-MV x-band linear accelerator (LINAC) mounted on a computer-controlled robotic arm. Targeting solutions for the LINAC are based on image guidance through using two ceiling-mounted diagnostic x-ray sources with table-mounted flat-panel detectors [4]. For precise image localization, percutaneously placed metal markers (fiducials) are inserted in, or adjacent to, the tumor. Using “real-time” image processing, data from the two oblique images

Patients

Twenty-three patients were enrolled at the two institutions. There were 13 men and 9 women. The age range was 23 to 87 years (mean, 63 years). Fifteen patients had primary lung tumors and 8 had metastatic tumors; 2 patients underwent radiosurgery to two lesions. Tumor size ranged from 1 to 5 cm in maximal diameter. Nine patients were treated with a breath-holding technique, and 14 with a respiratory-tracking, automated, robotic technique. The median treatment time was approximately 4 hours

Comment

This is the first report of clinical outcomes that follows the use of single-fraction frameless stereotactic radiosurgery being used to treat tumors of the lung. It presents the initial results of a three-phase, dose-escalation study with the CyberKnife stereotactic radiosurgery system. Other reports of stereotactic radiation to lung tumors have involved either multiple fractions or frame-based systems, and previous reports of the CyberKnife system have focused on intracranial, spinal, and

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Original article: general thoracicStereotactic radiosurgery for lung tumors: preliminary report of a phase I trial

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Patients

Comment

Int J Radiat Oncol Biol Phys

Ann Thorac Surg

Resectable non-small cell lung cancer in the medically inoperable patientcurative management with radiation therapy

The stereotactic method and radiosurgery of the brain

Acta Chir Scand

The Cyberknifea frameless robotic system for radiosurgery

Stereotact Funct Neurosurg

A real-time, flat-panel, amorphous silicon, digital x-ray imager

Radiographics

Original article: general thoracic
Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial