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Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: A noninvasive treatment approach in medically inoperable patients

2004; Elsevier BV; Volume: 60; Issue: 1 Linguagem: Inglês

10.1016/j.ijrobp.2004.02.060

1879-355X

Joern Wulf, Ulrich Haedinger, Ulrich Oppitz, Wibke Thiele, Gerd Mueller, Michael Flentje,

Medical Imaging Techniques and Applications

Abstract Purpose The clinical results of dose escalation using stereotactic radiotherapy to increase local tumor control in medically inoperable patients with Stage I-II non–small-cell lung cancer or pulmonary metastases were evaluated. Methods and materials Twenty patients with Stage I-II non–small-cell lung cancer and 41 patients with 51 pulmonary metastases not amenable to surgery were treated with stereotactic radiotherapy at 3 × 10 Gy ( n = 19), 3 × 12–12.5 Gy to the planning target volume enclosing 100%–isodose, with normalization to 150% at the isocenter; n = 26) or 1 × 26 Gy to the planning target volume enclosing 80%–isodose ( n = 26). The median follow-up was 11 months (range, 2–61 months) for primary lung cancer patients and 9 months (range, 2–37 months) for patients with metastases. Results The actuarial local control rate was 92% for lung cancer patients and 80% for metastasis patients ≥1 year after treatment and was significantly improved by increasing the dose from 3 × 10 Gy to 3 × 12–12.5 Gy or 1 × 26 Gy ( p = 0.038). The overall survival rate after 1 and 2 years was 52% and 32%, respectively, for lung cancer patients and 85% and 33%, respectively, for metastasis patients, impaired because of systemic disease progression. After 12 months, 60% of patients with primary lung cancer and 35% of patients with pulmonary metastases were without systemic progression. No severe acute or late toxicity was observed, and only 2 patients (3%) developed symptomatic Grade 2 pneumonitis, which was successfully treated with oral steroids. Conclusion Stereotactic radiotherapy for lung tumors offers a very effective treatment option locally without significant complications in medically impaired patients who are not amenable to surgery. Patient selection is important, because those with a low risk of systemic progression are more likely to benefit from this approach.