Hiromitsu Iwata1,2, Satoshi Ishikura3, Taro Murai3, Michio Iwabuchi4, Mitsuhiro Inoue5, Koshi Tatewaki6, Seiji Ohta6, Naoki Yokota7, Yuta Shibamoto3. 1. Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan. h-iwa-ncu@nifty.com. 2. Department of Radiology, Yokohama CyberKnife Center, 574-1 Ichizawa-cho, Asahi-ku, Yokohama, 241-0014, Japan. h-iwa-ncu@nifty.com. 3. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. 4. Department of Radiology, Yokohama CyberKnife Center, 574-1 Ichizawa-cho, Asahi-ku, Yokohama, 241-0014, Japan. 5. Division of Quality Management with Radiation, Yokohama CyberKnife Center, 574-1 Ichizawa-cho, Asahi-ku, Yokohama, 241-0014, Japan. 6. Department of Neurosurgery, Yokohama CyberKnife Center, 574-1 Ichizawa-cho, Asahi-ku, Yokohama, 241-0014, Japan. 7. Radiation Oncology Center, Suzukake Central Hospital, 120-1 Tajiri-cho, Minami-Ku, Hamamatsu, 432-8054, Japan.
Abstract
BACKGROUND: In this phase I/II study, we assessed the safety and initial efficacy of stereotactic body radiotherapy (SBRT) for lung tumors with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm. METHODS: Study subjects had histologically confirmed primary non-small-cell lung cancer staged as T1a-T2aN0M0 and pulmonary oligometastasis. The primary endpoint was the incidence of Grade ≥3 radiation pneumonitis (RP) within 180 days of the start of SBRT. The secondary endpoint was local control and overall survival rates. Five patients were initially enrolled at level 1 [50 Gy/4 fractions (Fr)]; during the observation period, level 0 (45 Gy/4 Fr) was opened. The dose was escalated to the next level when grade ≥3 RP was observed in 0 out of 5 or 1 out of 10 patients. Virtual quality assurance planning was performed for 60 Gy/4 Fr; however, dose constraints for the organs at risk did not appear to be within acceptable ranges. Therefore, level 2 (55 Gy/4 Fr) was regarded as the upper limit. After the recommended dose (RD) was established, 15 additional patients were enrolled at the RD. The prescribed dose was normalized at the 95% volume border of the planning target volume based on the Monte Carlo algorithm. RESULTS: Between September 2011 and September 2015, 40 patients (primary 30; metastasis 10) were enrolled. Five patients were enrolled at level 0, 15 at level 1, and 20 at level 2. Only one grade 3 RP was observed at level 1. Two-year local control and overall survival rates were 98 and 81%, respectively. CONCLUSION: The RD was 55 Gy/4 Fr. SBRT with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm was tolerated well and appeared to be effective for solitary lung tumors.
BACKGROUND: In this phase I/II study, we assessed the safety and initial efficacy of stereotactic body radiotherapy (SBRT) for lung tumors with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm. METHODS: Study subjects had histologically confirmed primary non-small-cell lung cancer staged as T1a-T2aN0M0 and pulmonary oligometastasis. The primary endpoint was the incidence of Grade ≥3 radiation pneumonitis (RP) within 180 days of the start of SBRT. The secondary endpoint was local control and overall survival rates. Five patients were initially enrolled at level 1 [50 Gy/4 fractions (Fr)]; during the observation period, level 0 (45 Gy/4 Fr) was opened. The dose was escalated to the next level when grade ≥3 RP was observed in 0 out of 5 or 1 out of 10 patients. Virtual quality assurance planning was performed for 60 Gy/4 Fr; however, dose constraints for the organs at risk did not appear to be within acceptable ranges. Therefore, level 2 (55 Gy/4 Fr) was regarded as the upper limit. After the recommended dose (RD) was established, 15 additional patients were enrolled at the RD. The prescribed dose was normalized at the 95% volume border of the planning target volume based on the Monte Carlo algorithm. RESULTS: Between September 2011 and September 2015, 40 patients (primary 30; metastasis 10) were enrolled. Five patients were enrolled at level 0, 15 at level 1, and 20 at level 2. Only one grade 3 RP was observed at level 1. Two-year local control and overall survival rates were 98 and 81%, respectively. CONCLUSION: The RD was 55 Gy/4 Fr. SBRT with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm was tolerated well and appeared to be effective for solitary lung tumors.
Entities:
Keywords:
CyberKnife; Lung tumors; Monte Carlo algorithm; Phase I/II study; Stereotactic body radiotherapy; Tracking
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