Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors

Brian T. Collins, Kelly Erickson, Cristina A. Reichner, Sean P. Collins, Gregory J. Gagnon, Sonja Dieterich, Don A. McRae, Ying Zhang, Shadi Yousefi, Elliot Levy, Thomas Chang, Carlos Jamis-Dow, Filip Banovac, Eric D. Anderson

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Abstract

Background: Recent developments in radiotherapeutic technology have resulted in a new approach to treating patients with localized lung cancer. We report preliminary clinical outcomes using stereotactic radiosurgery with real-time tumor motion tracking to treat small peripheral lung tumors. Methods: Eligible patients were treated over a 24-month period and followed for a minimum of 6 months. Fiducials (3-5) were placed in or near tumors under CT-guidance. Non-isocentric treatment plans with 5-mm margins were generated. Patients received 45-60 Gy in 3 equal fractions delivered in less than 2 weeks. CT imaging and routine pulmonary function tests were completed at 3, 6, 12, 18, 24 and 30 months. Results: Twenty-four consecutive patients were treated, 15 with stage I lung cancer and 9 with single lung metastases. Pneumothorax was a complication of fiducial placement in 7 patients, requiring tube thoracostomy in 4. All patients completed radiation treatment with minimal discomfort, few acute side effects and no procedure-related mortalities. Following treatment transient chest wall discomfort, typically lasting several weeks, developed in 7 of 11 patients with lesions within 5 mm of the pleura. Grade III pneumonitis was seen in 2 patients, one with prior conventional thoracic irradiation and the other treated with concurrent Gefitinib. A small statistically significant decline in the mean % predicted DLCO was observed at 6 and 12 months. All tumors responded to treatment at 3 months and local failure was seen in only 2 single metastases. There have been no regional lymph node recurrences. At a median follow-up of 12 months, the crude survival rate is 83%, with 3 deaths due to co-morbidities and 1 secondary to metastatic disease. Conclusion: Radical stereotactic radiosurgery with real-time tumor motion tracking is a promising well-tolerated treatment option for small peripheral lung tumors.

Original languageEnglish (US)
Article number39
JournalRadiation Oncology
Volume2
Issue number1
DOIs
StatePublished - Oct 22 2007
Externally publishedYes

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ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Collins, B. T., Erickson, K., Reichner, C. A., Collins, S. P., Gagnon, G. J., Dieterich, S., McRae, D. A., Zhang, Y., Yousefi, S., Levy, E., Chang, T., Jamis-Dow, C., Banovac, F., & Anderson, E. D. (2007). Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors. Radiation Oncology, 2(1), [39]. https://doi.org/10.1186/1748-717X-2-39