C Wesley Hodge1, Wolfgang A Tomé2,3, Tracy Weigel4, Anne M Traynor2, Minesh P Mehta5. 1. Robert Boissoneault Oncology Institute, Ocala, FL 34471, Departments of. 2. Human Oncology. 3. Medical Physics, and. 4. Surgery, University of Wisconsin Hospital and Clinics, Madison, WI. 5. Department of Medical Physics, Feinberg School of Medicine, Northwestern University, Evanston, IL.
Abstract
OBJECTIVES: A patient specific nomogram based biological dose selection (NBDS) model may allow for selection of a safe and effective dose schedule to treat early peripheral stage non-small cell lung cancer (NSCLC) with stereotactic body radiotherapy (SBRT). We report the initial clinical outcomes testing these concepts. METHODS: 23 patients with stage IA/B NSCLC were treated with SBRT. All patients had a prescription isodose volume/residual lung volume ratio of 2-3%, permitting a wide range of dose fractionation schemes under the NBDS-model that should yield a sufficiently low grade 2 or higher pneumonitis rate that the resultant long-term grade 3 or higher complication rate would be <20%. Based on the predications of the patient specific NBDS-model all patients could be safely treated using a modal prescription of 60 Gy in 5 fractions over 10 calendar days, with a median normalized tissue dose (NTD) of 122.4 Gy10. Kaplan-Meier analysis was performed to assess local control, overall, cause-specific and disease free survival. Toxicities and response rates were analyzed. RESULTS: Median follow-up was 43.2 months for all living patients. Analysis of 20 evaluable lesions demonstrated a major response rate of 80%. 3 year actuarial overall, cause-specific, and disease free survival, were 60, 79, and 55%, respectively. 3 year actuarial local control was 89%. Grade 2 or higher acute pulmonary toxicity was observed in 5 patients. The 1, 2 and 3-year actuarial incidence of grade 2 or higher pulmonary toxicity was 15, 27 and 27% (95% CI = 5 48%), with corresponding grade 3 incidence of 4, 10, and 10%. No grade 3 or higher non-pulmonary side-effects were observed. CONCLUSIONS: SBRT using a biological model-based fractionation scheme yields local control and survival rates comparable to other series that treat to higher NTDs; the pulmonary toxicity rate and grades are within the model-predicted parameters, but further follow-up is necessary for long-term validity of the model.
OBJECTIVES: A patient specific nomogram based biological dose selection (NBDS) model may allow for selection of a safe and effective dose schedule to treat early peripheral stage non-small cell lung cancer (NSCLC) with stereotactic body radiotherapy (SBRT). We report the initial clinical outcomes testing these concepts. METHODS: 23 patients with stage IA/B NSCLC were treated with SBRT. All patients had a prescription isodose volume/residual lung volume ratio of 2-3%, permitting a wide range of dose fractionation schemes under the NBDS-model that should yield a sufficiently low grade 2 or higher pneumonitis rate that the resultant long-term grade 3 or higher complication rate would be <20%. Based on the predications of the patient specific NBDS-model all patients could be safely treated using a modal prescription of 60 Gy in 5 fractions over 10 calendar days, with a median normalized tissue dose (NTD) of 122.4 Gy10. Kaplan-Meier analysis was performed to assess local control, overall, cause-specific and disease free survival. Toxicities and response rates were analyzed. RESULTS: Median follow-up was 43.2 months for all living patients. Analysis of 20 evaluable lesions demonstrated a major response rate of 80%. 3 year actuarial overall, cause-specific, and disease free survival, were 60, 79, and 55%, respectively. 3 year actuarial local control was 89%. Grade 2 or higher acute pulmonary toxicity was observed in 5 patients. The 1, 2 and 3-year actuarial incidence of grade 2 or higher pulmonary toxicity was 15, 27 and 27% (95% CI = 5 48%), with corresponding grade 3 incidence of 4, 10, and 10%. No grade 3 or higher non-pulmonary side-effects were observed. CONCLUSIONS: SBRT using a biological model-based fractionation scheme yields local control and survival rates comparable to other series that treat to higher NTDs; the pulmonary toxicity rate and grades are within the model-predicted parameters, but further follow-up is necessary for long-term validity of the model.
Entities:
Keywords:
Cancer; Lung; Radiobiology; Radiotherapy; Stereotactic body radiotherapy
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