Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 72, Issue 4, Pages 967-971Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2008.08.001
Keywords
SBRT; 4D CT; Central/superior lesion; NSCLC; Adverse effect
Funding
- NCI NIH HHS [R01 CA074043, P30 CA016672, P50 CA070907] Funding Source: Medline
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Purpose: To evaluate the efficacy and adverse effects of image-guided stereotactic body radiation therapy (SBRT) in centrally/superiorly located non-small-cell lung cancer (NSCLC). Materials and Methods: We delivered SBRT to 27 patients, 13 with Stage I and 14 with isolated recurrent NSCLC. A centrat/superior location was defined as being within 2 cm of the bronchial tree, major vessels, esophagus, heart, trachea, pericardium, brachial plexus, or vertebral body, but 1 cm away from the spinal canal. All patients underwent four-dimensional computed tomography-based planning, and daily computed tomography-on-rail guided SBRT. The prescribed dose of 40 Gy (n = 7) to the planning target volume was escalated to 50 Gy (n = 20) in 4 consecutive days. Results: With a median follow-up of 17 months (range, 6-40 months), the crude local control at the treated site was 100% using 50 Gy. However, 3 of 7 patients had local recurrences when treated using 40 Gy. Of the patients with Stage I disease, 1 (7.7%) and 2 (15.4%) developed mediastinal lymph node metastasis and distant metastases, respectively. Of the patients with recurrent disease, 3 (21.4%) and 5 (35.7%) developed mediastinal lymph node metastasis and distant metastasis, respectively. Four patients (28.6%) with recurrent disease but none with Stage I disease developed Grade 2 pneumonitis. Three patients (11.1%) developed Grade 2-3 dermatitis and chest wall pain. One patient developed brachial plexus neuropathy. No esophagitis was noted in any patient. Conclusions: Image-guided SBRT using 50 Gy delivered in four fractions is feasible and resulted in excellent local control. (C) 2008 Elsevier Inc.
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