Tumor volume-adapted dosing in stereotactic ablative radiotherapy of lung tumors

Nicholas Trakul, Christine N. Chang, Jeremy Harris, Christopher Chapman, Aarti Rao, John Shen, Sean Quinlan-Davidson, Edith J. Filion, Heather A. Wakelee, A. Dimitrios Colevas, Richard I. Whyte, Sonja Dieterich, Peter G. Maxim, Dimitre Hristov, Phuoc Tran, Quynh Thu Le, Billy W. Loo, Maximilian Diehn

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Abstract

Purpose: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. Methods and Materials: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18-25 Gy) (Group 1), and larger tumors (gross tumor volume ≥12 mL) received multifraction regimens with BED ≥100 Gy (total dose, 50-60 Gy in three to four fractions) (Group 2). Results: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). Conclusion: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.

Original languageEnglish (US)
Pages (from-to)231-237
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume84
Issue number1
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

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Keywords

  • Biologically effective dose
  • Lung cancer
  • Metastases
  • Stereotactic ablative radiotherapy
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Trakul, N., Chang, C. N., Harris, J., Chapman, C., Rao, A., Shen, J., Quinlan-Davidson, S., Filion, E. J., Wakelee, H. A., Colevas, A. D., Whyte, R. I., Dieterich, S., Maxim, P. G., Hristov, D., Tran, P., Le, Q. T., Loo, B. W., & Diehn, M. (2012). Tumor volume-adapted dosing in stereotactic ablative radiotherapy of lung tumors. International Journal of Radiation Oncology Biology Physics, 84(1), 231-237. https://doi.org/10.1016/j.ijrobp.2011.10.071