Stereotactic body radiation therapy of lung tumors: Preliminary experience using normal tissue complication probability-based dose limits

Danny Y. Song, Stanley H Benedict, Robert M. Cardinale, Theodore D. Chung, Michael G. Chang, Rupert K. Schmidt-Ullrich

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objectives: To assess the feasibility and toxicity of stereotactic body radiotherapy (SBRT) for patients with locally advanced or metastatic tumors in lung. Methods: Twenty-five tumors in 17 patients were treated. All treatments were delivered in 3 daily fractions of 9 to 15 Gy per fraction. Normal tissue complication probability (NTCP) calculations (using the Lyman model) were performed to facilitate dose prescription, and doses were prescribed with a maximum allowable NTCP risk of pneumonitis of up to 20%, not to exceed 15 Gy per fraction. Planning target volumes were designed to allow for respiratory variation in tumor location. Results: The median dose prescribed was 35 Gy (range, 24 to 45 Gy). Twenty-three of 25 tumors remained controlled at median follow-up of 14 months. Four patients experienced grade 1-2 acute toxicity. Late toxicity developed in 2 patients who received treatment to peri-hilar tumors, including one patient in whom bronchial stenosis developed with complete occlusion and lobar atelectasis 6 months after treatment. No patient had grade 3 or 4 radiation pneumonitis. Conclusions: SBRT prescribed within the confines of NTCP-restricted dosing on this protocol resulted in no radiation pneumonitis. Tissues other than lung parenchyma which are unaccounted for by NTCP may be dose-limiting when performing hypofractionated SBRT in the lung.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume28
Issue number6
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Radiotherapy
Lung
Radiosurgery
Radiation Pneumonitis
Neoplasms
Pulmonary Atelectasis
Prescriptions
Pneumonia
Pathologic Constriction
Therapeutics

Keywords

  • Extracranial radiosurgery
  • Lung
  • Normal tissue complication probability
  • Stereotactic body radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Stereotactic body radiation therapy of lung tumors : Preliminary experience using normal tissue complication probability-based dose limits. / Song, Danny Y.; Benedict, Stanley H; Cardinale, Robert M.; Chung, Theodore D.; Chang, Michael G.; Schmidt-Ullrich, Rupert K.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 28, No. 6, 12.2005, p. 591-596.

Research output: Contribution to journalArticle

Song, Danny Y. ; Benedict, Stanley H ; Cardinale, Robert M. ; Chung, Theodore D. ; Chang, Michael G. ; Schmidt-Ullrich, Rupert K. / Stereotactic body radiation therapy of lung tumors : Preliminary experience using normal tissue complication probability-based dose limits. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2005 ; Vol. 28, No. 6. pp. 591-596.
@article{80739b642a294547a7a3b92c12539ad4,
title = "Stereotactic body radiation therapy of lung tumors: Preliminary experience using normal tissue complication probability-based dose limits",
abstract = "Objectives: To assess the feasibility and toxicity of stereotactic body radiotherapy (SBRT) for patients with locally advanced or metastatic tumors in lung. Methods: Twenty-five tumors in 17 patients were treated. All treatments were delivered in 3 daily fractions of 9 to 15 Gy per fraction. Normal tissue complication probability (NTCP) calculations (using the Lyman model) were performed to facilitate dose prescription, and doses were prescribed with a maximum allowable NTCP risk of pneumonitis of up to 20{\%}, not to exceed 15 Gy per fraction. Planning target volumes were designed to allow for respiratory variation in tumor location. Results: The median dose prescribed was 35 Gy (range, 24 to 45 Gy). Twenty-three of 25 tumors remained controlled at median follow-up of 14 months. Four patients experienced grade 1-2 acute toxicity. Late toxicity developed in 2 patients who received treatment to peri-hilar tumors, including one patient in whom bronchial stenosis developed with complete occlusion and lobar atelectasis 6 months after treatment. No patient had grade 3 or 4 radiation pneumonitis. Conclusions: SBRT prescribed within the confines of NTCP-restricted dosing on this protocol resulted in no radiation pneumonitis. Tissues other than lung parenchyma which are unaccounted for by NTCP may be dose-limiting when performing hypofractionated SBRT in the lung.",
keywords = "Extracranial radiosurgery, Lung, Normal tissue complication probability, Stereotactic body radiotherapy",
author = "Song, {Danny Y.} and Benedict, {Stanley H} and Cardinale, {Robert M.} and Chung, {Theodore D.} and Chang, {Michael G.} and Schmidt-Ullrich, {Rupert K.}",
year = "2005",
month = "12",
doi = "10.1097/01.coc.0000182428.56184.af",
language = "English (US)",
volume = "28",
pages = "591--596",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Stereotactic body radiation therapy of lung tumors

T2 - Preliminary experience using normal tissue complication probability-based dose limits

AU - Song, Danny Y.

AU - Benedict, Stanley H

AU - Cardinale, Robert M.

AU - Chung, Theodore D.

AU - Chang, Michael G.

AU - Schmidt-Ullrich, Rupert K.

PY - 2005/12

Y1 - 2005/12

N2 - Objectives: To assess the feasibility and toxicity of stereotactic body radiotherapy (SBRT) for patients with locally advanced or metastatic tumors in lung. Methods: Twenty-five tumors in 17 patients were treated. All treatments were delivered in 3 daily fractions of 9 to 15 Gy per fraction. Normal tissue complication probability (NTCP) calculations (using the Lyman model) were performed to facilitate dose prescription, and doses were prescribed with a maximum allowable NTCP risk of pneumonitis of up to 20%, not to exceed 15 Gy per fraction. Planning target volumes were designed to allow for respiratory variation in tumor location. Results: The median dose prescribed was 35 Gy (range, 24 to 45 Gy). Twenty-three of 25 tumors remained controlled at median follow-up of 14 months. Four patients experienced grade 1-2 acute toxicity. Late toxicity developed in 2 patients who received treatment to peri-hilar tumors, including one patient in whom bronchial stenosis developed with complete occlusion and lobar atelectasis 6 months after treatment. No patient had grade 3 or 4 radiation pneumonitis. Conclusions: SBRT prescribed within the confines of NTCP-restricted dosing on this protocol resulted in no radiation pneumonitis. Tissues other than lung parenchyma which are unaccounted for by NTCP may be dose-limiting when performing hypofractionated SBRT in the lung.

AB - Objectives: To assess the feasibility and toxicity of stereotactic body radiotherapy (SBRT) for patients with locally advanced or metastatic tumors in lung. Methods: Twenty-five tumors in 17 patients were treated. All treatments were delivered in 3 daily fractions of 9 to 15 Gy per fraction. Normal tissue complication probability (NTCP) calculations (using the Lyman model) were performed to facilitate dose prescription, and doses were prescribed with a maximum allowable NTCP risk of pneumonitis of up to 20%, not to exceed 15 Gy per fraction. Planning target volumes were designed to allow for respiratory variation in tumor location. Results: The median dose prescribed was 35 Gy (range, 24 to 45 Gy). Twenty-three of 25 tumors remained controlled at median follow-up of 14 months. Four patients experienced grade 1-2 acute toxicity. Late toxicity developed in 2 patients who received treatment to peri-hilar tumors, including one patient in whom bronchial stenosis developed with complete occlusion and lobar atelectasis 6 months after treatment. No patient had grade 3 or 4 radiation pneumonitis. Conclusions: SBRT prescribed within the confines of NTCP-restricted dosing on this protocol resulted in no radiation pneumonitis. Tissues other than lung parenchyma which are unaccounted for by NTCP may be dose-limiting when performing hypofractionated SBRT in the lung.

KW - Extracranial radiosurgery

KW - Lung

KW - Normal tissue complication probability

KW - Stereotactic body radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=29044442321&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=29044442321&partnerID=8YFLogxK

U2 - 10.1097/01.coc.0000182428.56184.af

DO - 10.1097/01.coc.0000182428.56184.af

M3 - Article

C2 - 16317270

AN - SCOPUS:29044442321

VL - 28

SP - 591

EP - 596

JO - American Journal of Clinical Oncology

JF - American Journal of Clinical Oncology

SN - 0277-3732

IS - 6

ER -