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Hypofractionated Conformal Radiotherapy (HCRT) for Primary and Metastatic Lung Cancers with Small Dimension

Efficacy and Toxicity

Hypofraktionierte konformale Radiotherapie (HCRT) bei primären und metastasierten Lungenkarzinomen kleinen Ausmaßes. Effizienz und Toxizität

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Purpose:

To report on the clinical outcome of hypofractionated conformal radiotherapy (HCRT) for medically inoperable stage I non-small cell lung carcinoma (NSCLC) or limited pulmonary metastases ≤ 5 cm in diameter.

Patients and Methods:

From June 2003 to March 2007, 40 patients (42 lesions) underwent HCRT consisting of 40 Gy in five fractions over 2.5 weeks received by at least 95% of planning target volume. All patients underwent CT simulation and treatment under free shallow breathing. To evaluate target displacement under respiratory activity, two additional CT scans were performed with breath-holding during the expiratory and inspiratory phases. Of all patients enrolled, those with a follow-up ≥ 4 months were considered suitable for analysis. Local response was evaluated with CT imaging 4 months after the end of HCRT and every 3 months thereafter. Local relapse-free survival (LRFS) and overall survival (OS) were calculated with the Kaplan-Meier method.

Results:

Local response to the treatment was complete response, partial response, no change, and progressive disease as seen in 29%, 43%, 14%, and 7% of tumors, respectively. LRFS at 1 year and 3 years was 76% and 63%, respectively. Lung toxicities ≥ grade 2 were observed in 4/40 patients, but no grade 4. Pericardial effusion occurred in one patient. In stage I NSCLC patients (n = 15) with a median follow-up of 25 months, the 1-year LRFS and OS rates were 88% and 81%, respectively, and the 3-year rates 72% and 61%, respectively.

Conclusion:

HCRT is an effective and low-toxic treatment for medically inoperable early-stage lung cancers and pulmonary metastases for all clinicians lacking the aid of a dedicated stereotactic system.

Ziel:

Klinische Auswertung einer hypofraktionierten konformalen Radiotherapie (HCRT) bei inoperablen nichtkleinzelligen Bronchialkarzinomen (NSCLC) im Stadium I oder isolierten Lungenmetastasen mit einem Durchmesser ≤ 5 cm.

Patienten und Methodik:

Von Juni 2003 bis März 2007 wurden 40 Patienten (42 Zielvolumina) einer CT-Simulation und HCRT (40 Gy in fünf Fraktionen uber 2,5 Wochen) von mindestens 95% des Planungszielvolumens unterzogen. In allen Fällen erfolgten die CT-Simulation und die Bestrahlung bei freier flacher Atmung. Zur Abschätzung der Zielvolumenverschiebung aufgrund der Atembewegung wurden zwei weitere CTs erstellt, während die Patienten den Atem jeweils in In- und Exspiration anhielten. Patienten mit einer Nachbeobachtungszeit von ≥ 4 Monaten wurden in die Studie eingeschlossen. Die lokale Ansprechrate wurde 4 Monate nach Behandlungsende und anschließend alle 3 Monate mittels CT ausgewertet. Lokalrezidivfreies Überleben (LRFS) und Gesamtüberleben (OS) wurden mit der Kaplan-Meier-Methode berechnet.

Ergebnisse:

Bezüglich des lokalen Therapieansprechens fanden sich Raten von 29%, 43%, 14% bzw. 7% für komplette Remission, partielle Remission, keine Veränderung bzw. Krankheitsprogression. Das 1- und das 3-Jahres-LRFS betrugen 76% und 63%. Lungentoxizitäten ≥ Grad 2 wurden bei 4/40 Patienten beobachtet, wobei allerdings keine Grad-4-Toxizitat auftrat. Bei einem Patienten kam es zu einem Perikarderguss. Bei NSCLC-Patienten im Stadium I (n = 15) mit einem durchschnittlichen Nachbeobachtungszeitraum von 25 Monaten betrugen die LRFS- und OS-Raten nach 1 Jahr 88% und 81% sowie nach 3 Jahren 72% und 61%.

Schlussfolgerung:

Die HCRT ist ein effektives und wenig toxisches Verfahren zur Behandlung inoperabler Patienten mit primären Lungenkarzinomen im Frühstadium und pulmonalen Metastasen.

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Authors and Affiliations

  1. S.C. Radioterapia Oncologica, Regina Elena National Cancer Institute, Rome, Italy

    Maria Alessandra Mirri MD, Giorgio Arcangeli & Valentina Pinzi

  2. S.C. Laboratorio di Fisica Medica e Sistemi Esperti, Regina Elena National Cancer Institute, Rome, Italy

    Marcello Benassi, Annelisa d’Angelo & Lidia Strigari

  3. S.C. Radiologia e Diagnostica per Immagini, Regina Elena National Cancer Institute, Rome, Italy

    Mauro Caterino

  4. S.C. Oncologia Medica B, Regina Elena National Cancer Institute, Rome, Italy

    Massimo Rinaldi

  5. S.C. Oncologia Medica A, Regina Elena National Cancer Institute, Rome, Italy

    Anna Ceribelli

  6. Via E. Chianesi 53, 00144, Roma, Italy

    Maria Alessandra Mirri MD

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  1. Maria Alessandra Mirri MD
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Mirri, M.A., Arcangeli, G., Benassi, M. et al. Hypofractionated Conformal Radiotherapy (HCRT) for Primary and Metastatic Lung Cancers with Small Dimension. Strahlenther Onkol 185, 27–33 (2009). https://doi.org/10.1007/s00066-009-1873-3

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  • DOI: https://doi.org/10.1007/s00066-009-1873-3

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