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Stereotactic ablative radiotherapy for small lung tumors with a moderate dose

Favorable results and low toxicity

Stereotaktische ablative Strahlentherapie mit mittlerer Dosis bei kleinen Lungentumoren

Günstige Ergebnisse und geringe Toxizität

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Abstract

Background

Stereotactic ablative body radiotherapy (SBRT, SABR) is being increasingly applied because of its high local efficacy, e.g., for small lung tumors. However, the optimum dosage is still under discussion. Here, we report data on 45 lung lesions [non-small cell lung cancer (NSCLC) or metastases] in 39 patients treated between 2009 and 2010 by SABR.

Patients and methods

SABR was performed with total doses of 35 Gy (5 fractions) or 37.5 Gy (3 fractions) prescribed to the 60% isodose line encompassing the planning target volume. Three-monthly follow-up CT scans were supplemented by FDG-PET/CT if clinically indicated.

Results

The median follow-up was 17 months. Local progression-free survival rates were 90.5% (all patients), 95.0% (NSCLC), and 81.8% (metastases) at 1 year. At 2 years, the respective local progression-free survival rates were 80.5%, 95.0%, and 59.7%. Overall survival rates were 71.1% (all patients), 65.4% (NSCLC), and 83.3% (metastases) at 1 year. Overall survival rates at 2 years were 52.7%, 45.9%, and 66.7%, respectively. Acute side effects were mild.

Conclusion

With the moderate dose schedule used, well-tolerated SABR led to favorable local tumor control as in other published series. Standardization in reporting the dose prescription for SABR is needed to allow comparison of different series in order to determine optimum dosage.

Zusammenfassung

Hintergrund

Die stereotaktische Strahlentherapie („stereotactic ablative body radiotherapy“, SBRT, SABR) wird aufgrund ihrer hohen lokalen Effizienz beispielsweise im Bereich kleiner Lungentumoren zunehmend eingesetzt. Die optimale Dosisverschreibung ist jedoch nach wie vor nicht geklärt. In dieser Arbeit werden die Daten von 45 Lungentumoren [nichtkleinzelliges Bronchialkarzinom (NSCLC) oder Metastasen] bei 39 Patienten vorgestellt, die zwischen 2009 und 2010 mittels SABR behandelt wurden.

Patienten und Methoden

Die Patienten wurden mittels SABR mit einer Gesamtdosis von 35 Gy (5 Fraktionen) oder 37,5 Gy (3 Fraktionen) behandelt, die Dosisverschreibung erfolgte auf die 60% Isodose am Rand des Strahlentherapie-Planungsvolumens (PTV, „planning target volume“). Alle 3 Monate wurde eine Nachsorge-Computertomographie (CT) durchgeführt, ergänzt durch Fluordeoxyglukose-Positronenemissionstomographie-CT, wenn klinisch indiziert.

Ergebnisse

Das mediane Follow-up betrug 17 Monate. Das lokal progressionsfreie Überleben nach einem Jahr betrug 90,5% (für alle Patienten); 95,0% (bei NSCLC) bzw. 81,8% (bei Metastasen). Nach 2 Jahren betrug das lokal progressionsfreie Überleben jeweils 80,5; 95,0 bzw. 59,7%. Das Gesamtüberleben nach einem Jahr betrug 71,1% (alle Patienten); 65,4% (NSCLC) bzw. 83,3% (Metastasen). Das Gesamtüberleben nach 2 Jahren betrug jeweils 52,7; 45,9 bzw. 66,7%. Akute Nebenwirkungen waren nur gering ausgeprägt.

Schlussfolgerung

Mit der hier verwendeten moderaten Dosisverschreibung wurde eine gute Tumorkontrolle erreicht. Eine standardisierte Darstellung der Dosisverschreibung wird vor allem für die Vergleichbarkeit von Patientenkollektiven untereinander als notwendig erachtet.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Universitätsklinikum Freiburg, Freiburg, Germany

    V. Duncker-Rohr MD, U. Nestle MD, PhD, V. Prokic PhD, F. Heinemann MD, M. Mix PhD, J. Reusch MD, M.-B. Messmer MD, C.F. Waller MD, PhD, W.A. Weber MD, PhD & A.-L. Grosu MD, PhD

  2. Ortenau Klinikum Offenburg, Offenburg, Germany

    F. Momm MD, PhD

  3. Praxis für Interdisziplinäre Onkologie und Hämatologie Freiburg, Freiburg, Germany

    N. Marschner MD

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  1. V. Duncker-Rohr MD
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  2. U. Nestle MD, PhD
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  3. F. Momm MD, PhD
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  4. V. Prokic PhD
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  5. F. Heinemann MD
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  11. W.A. Weber MD, PhD
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  12. A.-L. Grosu MD, PhD
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Correspondence to V. Duncker-Rohr MD.

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Duncker-Rohr, V., Nestle, U., Momm, F. et al. Stereotactic ablative radiotherapy for small lung tumors with a moderate dose. Strahlenther Onkol 189, 33–40 (2013). https://doi.org/10.1007/s00066-012-0224-y

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