Evaluation of lung injury after three-dimensional conformal stereotactic radiation therapy for solitary lung tumors: CT appearance

PURPOSE: To evaluate the computed tomographic (CT) appearance of tumors and lung injury in patients who have undergone stereotactic radiation therapy (SRT) for solitary lung tumors. MATERIALS AND METHODS: Twenty-seven patients with primary lung cancer and four with metastatic lung cancer who underwent SRT for solitary lung tumors were enrolled for evaluation. SRT was delivered by using a three-dimensional conformal technique with a stereotactic body frame. A total dose of 48 Gy was administered in four fractions during a period of 2 weeks. After SRT, follow-up CT images were obtained every 2-3 months. Radiation-induced pulmonary injuries were classified into four patterns on CT images. The minimal lung dose to areas demonstrating pulmonary injury at CT was evaluated, and the correlation between the dose and the percentage volume of the whole lung irradiated by more than 20 Gy in total (V20) was assessed by using Spearman rank correlation. RESULTS: Tumor shrinkage continued for 2-15 months after SRT. Asymptomatic changes in the irradiated lung were noted at CT in all patients within 2-6 months (median, 4 months) after SRT. As the pattern at pulmonary CT changed, patchy consolidation was more predominantly seen as an acute change than were slight homogeneous increase in opacity, discrete consolidation, or solid consolidation; solid consolidation was the more predominantly seen late change. The minimal lung dose to the area demonstrating pulmonary injury in each patient ranged between 16 and 36 Gy (median, 24 Gy). The dose was significantly (P <.001) inversely correlated with the V20 in each patient. CONCLUSION: The reaction to SRT of the lungs seems similar to the reaction to conventional radiation therapy.     

Linear-accelerator-based stereotactic irradiation for metastatic brain tumors

To assess the safety and availability of stereotactic radiotherapy (SRT) for metastatic brain tumors, we reviewed 54 consecutive cases with a total of 118 brain metastases treated with linear-accelerator-based stereotactic irradiation (STI). Nineteen patients with a total of 27 brain tumors that were larger than 3 cm or close to critical normal tissues were treated with SRT. The marginal dose of SRT was 15-21 Gy (median 21 Gy) in 3 fractions for 3 days. The median marginal dose of stereotactic radiosurgery (SRS) was 20 Gy. Effective rates of imaging studies were 72.7% and 94.4%, and those of clinical symptoms were 46.7% and 55.6% for SRT and SRS, respectively. One-year and two-year survival rates of SRT were 40.9% and 17.6%, respectively, and the median follow-up period was 6.4 months. The one-year survival rate of SRS was 32.7%, with a median follow-up of 4.6 months. Fourteen cases (7 cases each) had recurrent tumors at STI sites. Early complications were observed in one case of SRT and 8 cases of SRS, and late complications occurred in 3 cases of SRS. There were no significant differences among effective rates, survival rates, median follow-up times, recurrence rates, and complications between SRT and SRS. We concluded that SRT is a safe, effective therapy for large or eloquent area metastases.     

Factors affecting the local control of stereotactic body radiotherapy for lung tumors including primary lung cancer and metastatic lung tumors

Purpose

To identify factors affecting local control of stereotactic body radiotherapy (SBRT) for lung tumors including primary lung cancer and metastatic lung tumors.

Materials and methods

Between June 2006 and June 2009, 159 lung tumors in 144 patients (primary lung cancer, 128; metastatic lung tumor, 31) were treated with SBRT with 48?C60?Gy (mean 50.1?Gy) in 4?C5 fractions. Higher doses were given to larger tumors and metastatic tumors in principle. Assessed factors were age, gender, tumor origin (primary vs. metastatic), histological subtype, tumor size, tumor appearance (solid vs. ground glass opacity), maximum standardized uptake value of positron emission tomography using ¹⁸F-fluoro-2-deoxy-d-glucose, and SBRT doses.

Results

Follow-up time was 1?C60?months (median 18?months). The 1-, 2-, and 3-year local failure-free rates of all lesions were 90, 80, and 77?%, respectively. On univariate analysis, metastatic tumors (p?p?=?0.0246), and higher SBRT doses (p?=?0.0334) were the statistically significant unfavorable factors for local control. On multivariate analysis, only tumor origin was statistically significant (p?=?0.0027). The 2-year local failure-free rates of primary lung cancer and metastatic lung tumors were 87 and 50?%, respectively.

Conclusions

A metastatic tumor was the only independently significant unfavorable factor for local control after SBRT.     

常规放疗结合后程立体定向放射治疗老年非小细胞肺癌患者的预后分析

目的观察老年非小细胞肺癌立体定向放疗疗效,并探讨其预后因子。方法128例老年非小细胞肺癌患者行常规放疗结合立体定向放疗,定期随访。结果全组患者1年生存率65.72%,单因素分析表明肿瘤体积、肿瘤剂量、卡氏评分影响近期结果,多因素分析仅肿瘤体积和肿瘤剂量为近期疗效预后因子,与生存期有关的预后因素为近期疗效、肿瘤剂量、临床分期。结论立体定向放疗可延长生存时间,对Ⅲ期患者,肿瘤剂量提高至72Gy是安全的。     

Efficacy of whole brain radiotherapy combined with fractionated stereotactic radiotherapy in metastatic brain tumors, and prognostic factors

PURPOSE: We attempted to analyze the effectiveness of whole brain radiotherapy (WBRT) combined with fractionated stereotactic radiotherapy (FSRT) in brain metastases. METHODS: Thirty-seven metastatic brain tumors in 29 patients without previous treatment were treated with WBRT plus FSRT, from October 1996 to February 2002. Four of the patients received stereotactic radiosurgery (SRS) prior to WBRT. Non-small cell lung cancer was the most common type of primary tumor (20/29). The total dose to the whole brain ranged from 30 Gy to 40 Gy, and the boost dose from FSRT ranged from 12 Gy to 40 Gy. End points were survival rate and local control rates. Factors influencing survival were evaluated. RESULTS: Median survival was 13 months, and actuarial survival rates at one and two years were 81% and 39%, respectively. Actuarial one and two year local control rates for all lesions were 78% and 71%, respectively. Survival was significantly associated with age, tumor size, presence of active extracranial tumors, and performance status. No acute or delayed complications were observed. CONCLUSIONS: We believe that WBRT plus FSRT should be included in the treatment options for metastatic brain tumors, and we consider the effect of this non-invasive method to be quite good in patients with good prognostic factors, although other invasive modalities could also be effective in them.     

Stereotactic radiotherapy for lung and liver tumors using a body cast system: setup accuracy and preliminary clinical outcome

PURPOSE: To evaluate the feasibility and treatment outcomes of stereotactic radiotherapy (SRT) using a newly developed simple body cast system for lung and liver tumors. MATERIALS AND METHODS: From April 2003 to July 2004, 20 patients were treated with SRT at the Kyushu University Hospital. Thirteen patients had primary lung cancer, 5 had metastatic lung cancer, and 2 had hepatocellular carcinoma. All patients were fixed with a thermoplastic body cast combined with a vacuum pillow, arm and leg support, and a carbon plate. SRT was given in 5-8 fields with an isocenter dose of 48-60 Gy in 4-10 fractions. Target verification was performed by computed tomography (CT) during the first session, and by anterior-posterior (A-P) and lateral portal images during the second and subsequent sessions. RESULTS: The average setup errors and deviation in the first treatment session were 1.4 +/- 1.2, 1.1 +/- 1.0, and 3.3 +/- 2.8 mm in the lateral, A-P, and cranio-caudal (C-C) directions, respectively. The setup errors in the second and subsequent sessions were 2.4 +/- 0.5, 1.4 +/- 1.8, and 3.7 +/- 2.6 mm in the lateral, A-P, and C-C directions, respectively. The patient's movement during a treatment session was within 5 mm in any direction. Despite the short follow-up periods (1-15 months), complete response was shown in 4 lesions, and partial response was shown in 15 lesions. Neither local progression nor serious complication was observed in any patient. CONCLUSION: SRT using our body cast system was a safe and reliable treatment method for extracranial tumors.     

Spontaneous pneumothorax after stereotactic radiotherapy for non-small-cell lung cancer

The report presented here describes a case of spontaneous pneumothorax observed after stereotactic radiotherapy (SRT) for non-small-cell lung cancer (NSCLC). An 84-year-old man with a Stage IIB, T3N0M0 NSCLC in the right upper lobe and a Stage IA NSCLC in the right lower lobe of the lung was treated with SRT for both tumors. He received SRT with a total dose of 60.0 Gy in 10 fractions delivered to the right upper lobe, and 48.0 Gy in 4 fractions delivered to the right lower lobe. Two months after completion of the treatment, he developed spontaneous pneumothorax. He was asymptomatic and recovered with conservative management. Spontaneous pneumothorax has occasionally been reported to occur following thoracic radiotherapy for malignancy. Almost all of the reported cases are patients who had received mantle irradiation for Hodgkin’s disease. We have been unable to fi nd any reports of spontaneous pneumothorax after SRT, which has recently been used for treating patients with early-stage NSCLC. Because a case of spontaneous pneumothorax after SRT was observed in our institution, its clinical course is described here along with a discussion of possible causes of spontaneous pneumothorax.     

Computed tomography appearance of high-dose-irradiated hepatic parenchyma surrounding small tumors after stereotactic radiotherapy

INTRODUCTION: The purpose of this study was to demonstrate the computed tomography (CT) appearance of high-dose-irradiated hepatic parenchyma surrounding small tumors after stereotactic radiotherapy (SRT). MATERIALS AND METHODS: Thirteen patients were enrolled between September 1999 and August 2001. We treated 15 lesions [six hepatocellular carcinomas (HCC) and nine liver metastases] with SRT using a linear accelerator. We used two SRT protocols of 45 Gy/3 fractions or 60 Gy/8 fractions. Hepatic CT examinations were performed at 3- to 4-month intervals after SRT. RESULTS: We classified the appearance of high-dose-irradiated hepatic parenchyma on CT into three types: Type 1: eight lesions (53.3%) showed low attenuation areas on non-contrast CT and high attenuation areas on contrast CT; Type 2: five lesions (33.3%) showed low attenuation areas on non-contrast and contrast CT; Type 3: two lesions (13.3%) showed no change. The CT appearance of Type 1 after SRT was similar to that of pre-irradiated HCC, but the other types were easily differentiated from the primary tumors. These changes were observed and continued for 6 to 22 months after treatment. In two cases of Type 1, we performed histological examinations of the regions of high attenuation on contrast CT. These specimens revealed only radiation-induced hepatic injury. CONCLUSION: This study showed three types of CT appearance in high-dose-irradiated hepatic parenchyma. We suggest that other examinations be considered to distinguish between radiation hepatitis and local recurrences for HCC after SRT.     

Radiation injury after hypofractionated stereotactic radiotherapy for peripheral small lung tumors: serial changes on CT

OBJECTIVE: We studied the serial changes and CT manifestations of pulmonary radiation injury after hypofractionated stereotactic radiation therapy for peripheral small lung tumors. SUBJECTS AND METHODS. Hypofractionated stereotactic radiation therapy was applied to 20 patients with proven primary (n = 11) or metastatic (n = 9) lung cancer, for a total of 22 lesions of 3 cm or less in diameter located within 3 cm from the parietal pleural surface. Follow-up CT was scheduled at 1 and 3 months, and every 3 months thereafter. RESULTS: Ground-glass opacities were observed around four (18%) of 22 lesions at 3-6 months. The opacities nearly corresponded to the planned target volume, but half of them were unevenly distributed. Ground-glass opacities gradually disappeared or evolved into dense consolidation while shrinking. Dense consolidations developed in 16 (73%) of 22 lesions, including seven in the center of the planned target volume and nine in the periphery of the planned target volume. Dense consolidations moved in six of these 16 lesions and gradually shrank, becoming fixed as solid or linear opacities approximately 12 months later. CONCLUSION: The pulmonary opacities observed after hypofractionated stereotactic radiation therapy for peripheral small lung tumors may not precisely correspond to the planned target volume (unlike those with conventional radiation therapy) and may change in shape and location dynamically during the first year. Knowledge of these findings is necessary to avoid misunderstandings concerning tumor regrowth or new tumors.     

伽玛刀立体定向放疗结合全脑照射治疗脑转移瘤临床效果分析

目的 分析立体定向放疗结合全脑照射治疗脑转移瘤的疗效和预后,同时观察服用替莫唑胺(TMZ)与放疗结合对患者生存率的影响。方法 脑转移瘤患者52例,按照治疗方法不同分为2组,一组为全脑照射(WBRT)+立体定向放疗(SRT,伽玛刀),共35例,一组为单纯SRT,共17例。全脑放疗分次剂量为1.8~3.0 Gy/次,1 次/d,5 次/周,总剂量D_T30~40 Gy,WBRT+SRT组全脑后伽玛刀补量采用45%~75%等剂量曲线包绕PTV,边缘剂量12~15 Gy,中心剂量20~30 Gy。单纯SRT组分次立体定向放疗采用45%~75%等剂量曲线包绕PTV,边缘剂量36~40 Gy,中心剂量70~80 Gy。随访1~2年。所选52例患者中有20例患者放疗期间及放疗后服用替莫唑胺胶囊,同步化疗组化疗方案为:口服替莫唑胺75 mg/m²,1次/d,直至放疗结束,放疗结束后再服用3~6个月,剂量改为150 mg/m²。结果 放射治疗后1~3个月,复查CT/MRI显示总有效率(CR+PR)为84.62%,WBRT+SRT组有效率为88.57%,SRT组有效率为76.47%;肿瘤的6个月及1年的局部控制率分别为92.10%和85.20%。WBRT+SRT组的平均生存期13.2个月,中位生存期11个月;6个月生存率为71.40%,12个月生存率为54.30%,18个月生存率为14.30%。SRT组的平均生存期10.2个月,中位生存期9个月;6个月生存率为41.20%,12个月生存率为23.50%,18个月生存率为5.88%。替莫唑胺+放疗与单纯放疗的6个月、12个月及18个月生存率分别为80.00%和56.30%、60.00%和37.50%、10.00%和12.50%。结论 WBRT+SRT治疗脑转移瘤总体上优于单纯SRT治疗。放疗+TMZ联合治疗与单纯放疗相比,替莫唑胺在放疗过程中服用可提高患者生存率,不良反应无显著增加。     

立体定向放射治疗胰腺癌

目的 对立体定向放射治疗胰腺癌的临床意义进行评价。方法 对16例胰腺癌患者行立体定向放射治疗,病变体积26.5~116.5cm3,肿瘤边缘单次剂量为3~5Gy,治疗10~20次,每日1次,每周治疗5次,治疗后临床和影像手段随访。结果 治疗有效率(完全缓解+部分缓解)为81.2%,合并疼痛患者均有不同程度缓解,6/7患者黄疸消除,生存质量明显改善,中位生存期11个月,死亡原因多为远处转移;治疗副作用根据RTOG标准评价,68.7%患者有轻度早期反应,1例重度晚期反应。结论 立体定向放射治疗胰腺癌是有效的局部控制手段,可明显的缓解症状,改善患者生存质量,并且治疗的并发症可以被临床接受,但肿瘤的远处转移是影响患者生存的主要问题。     

CyberKnife robotic image-guided stereotactic radiotherapy for oligometastic cancer

Purpose

To evaluate the outcome of robotic CyberKnife (Accuray Inc. Sunnyvale, USA)-based stereotactic radiotherapy (CBK-SRT) for oligometastic cancer patients.

Patients and methods

Between May 2007 and December 2009, 95 patients with a total of 118 lesions underwent CBK-SRT (median dose 24 Gy in 3 fractions). Inclusion criteria: adult patients with limited volume cancer; suitability for SRT but not for other local therapies. Primary diagnoses included breast, lung, head and neck, gastrointestinal and other malignancies. Prostate cancer patients were excluded. Concomitant systemic therapy was given in 40?% of cases and median follow-up was 12 months. Toxicity and tumor response were evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) Scale and Response Evaluation Criteria in Solid Tumors RECIST.

Results

Toxicity was rare and observed mainly in patients with comorbidities or uncontrolled cancer. Out of 87 evaluable lesions, complete radiological response, partial response, stabilization and progressive disease were observed in 15 (17?%), 25 (29?%), 34 (39?%) and 13 (15?%) lesions, respectively. Upon restricting the analysis to lesions treated with CBK-SRT alone (no concomitant therapy), response- and local control (LC) rates remained similar. Actuarial 3-year in-field progression-free survival- (i.e. LC), progression-free survival- (PFS) and overall-survival (OS) rates were 67.6, 18.4, and 31.2?%, respectively. LC was reduced in cases of early recurrence. OS- and cause-specific survival (CSS) rates were significantly lower in patients treated for visceral lesions. Failures were predominantly out-field.

Conclusion

CBK-SRT is a feasible therapeutic approach for oligometastastic cancer patients that provides long-term in-field tumor control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.     

Stereotactic hypofractionated radiotherapy of non-hepatic abdominal tumors

PURPOSE: The clinical experiences of 12 patients with non-hepatic abdominal tumors who underwent stereotactic hypofractionated radiotherapy are presented. METHODS AND MATERIALS: Ten lesions were metastatic, one was a primary pancreatic cancer, and the remaining one was irradiated postoperatively for a positive margin of extrahepatic bile duct cancer. In one patient, single fractional stereotactic radiotherapy was employed, while the remaining 11 patients were treated with 3 fractions. Gross tumor volume of the 10 ranged from 2 cc to 32 cc (mean: 11 cc), and the minimal dose enclosing 95% of the planning target volume (D95) was between 28.6 Gy and 35 Gy. The minimal number of portals was 6. In 8 patients, radiotherapy was performed under respiratory gating. Mean follow-up time was 10 months (5-51 months). RESULTS: Local regrowth was seen in 9 months in only 1 of the 12 tumors, and the patient died of the disease. Four patients died because of tumor growth in other sites. The remaining 7 patients are alive without disease. As for morbidity, NCI-CTC grade 3 gastritis was seen in one patient, grade 2 gastritis in 2 patients, and grade 2 duodenitis in one patient. These patients all improved with non-surgical therapy. CONCLUSION: Stereotactic hypofractionated radiotherapy is effective for the treatment of selected non-hepatic abdominal tumors. However, the optimal radiation dose for tumor control and the tolerance dose of the gastrointestinal tract in hypofractionated irradiation must be studied further.     

Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases

Purpose

The 1-year local control rates after single-fraction stereotactic radiotherapy (SRT) for brain metastases >?3?cm diameter are less than 70%, but with fractionated SRT (FSRT) higher local control rates have been reported. The purpose of this study was to compare our treatment results with SRT and FSRT for large brain metastases.

Materials and methods

In two consecutive periods, 41?patients with 46?brain metastases received SRT with 1 fraction of 15?Gy, while 51?patients with 65?brain metastases received FSRT with 3?fractions of 8?Gy. We included patients with brain metastases with a planning target volume of >?13?cm³ or metastases in the brainstem.

Results

The minimum follow-up of patients still alive was 22?months. Comparing 1?fraction of 15?Gy ?with 3?fractions of 8?Gy, the 1-year rates of freedom from any local progression (54% and 61%, p?=?0.93) and pseudo progression (85% and 75%, p?=?0.25) were not significantly different. Overall survival rates were also not different.

Conclusion

The 1-year local progression and pseudo progression rates after 1 fraction of 15?Gy or 3?fractions of 8?Gy for large brain metastases and metastases in the brainstem are similar. For better local control rates, FSRT schemes with a higher biological equivalent dose may be necessary.     

立体定向适形放射治疗前列腺癌30例临床分析

目的探讨立体定向适形放射治疗前列腺癌的临床应用价值。方法30例前列腺癌患者,26例放疗前行双侧睾丸切除术,20例同时服用内分泌治疗药物。全部采用WDVE-XKY808立体定向适形放射治疗系统照射前列腺靶区,5次/周,2 Gy/次,总剂量DT70~80 Gy。结果30例患者经立体定向适形放射治疗后3、6、12个月复查有效率分别为70%(21/30)、97%(29/30)、90%(27/30)6个月时病灶缩小最明显。1、3、5年总生存率分别为100.0%、85.0%、75.1%。结论立体定向适形放射治疗中晚期前列腺癌有较好的局部控制效果和较高的安全性,可作为前列腺癌姑息治疗的有效方法之一。     

Radiation bronchitis in lung cancer patient treated with stereotactic radiation therapy

We report a case of chronic radiation bronchitis that developed in a patient with lung cancer treated with fractionated stereotactic radiation therapy. A 73-year-old woman with a medically inoperable T1N0M0 adenocarcinoma of the lung was treated with stereotactic radiation therapy. By using eight non-coplanar ports, 50 Gy/5 fractions was delivered in two weeks. At four weeks, a partial response was obtained with no acute adverse reaction. She developed severe cough at six months. Fiberoptic bronchoscopy revealed thick circumferentially coated bronchial mucosa in close proximity to the tumor site. At 12 months, follow-up study confirmed marked stenotic change in the B6 segmental bronchus without tumor progression.     

Hypofractionated Stereotactic Radiotherapy for Primary and Secondary Intrapulmonary Tumors

PURPOSE: To evaluate the feasibility, efficacy, and side effects of dose escalation in hypofractionated stereotactic radiotherapy (hfSRT) for intrapulmonary tumors with the Novalis system (BrainLAB AG, Heimstetten, Germany). PATIENTS AND METHODS: From 07/2003 to 01/2005, 21 patients/39 tumors were treated with 5 x 7 Gy (n = 21; total dose 35 Gy) or 5 x 8 Gy (n = 18; total dose 40 Gy). There were three cases of primary lung cancer, the remainder were metastases. Median gross tumor volume (GTV) and planning target volume (PTV) were 2.89 cm(3) (range, 0.15-67.94 cm(3)) and 25.75 cm(3) (range, 7.18-124.04 cm(3)), respectively. RESULTS: Rates of complete remission, partial remission, no change, and progressive disease were 51%, 33%, 3%, and 13%, respectively. No grade 4 toxicity occurred, nearly all patients had grade 1 initially. One grade 3 toxicity, i.e., dyspnea, was documented for a period of 6 months after therapy. Radiosurgery quality assurance guidelines could be met. CONCLUSION: hfSRT of primary and secondary lung tumors using a schedule of five fractions at 7-8 Gy each was well tolerated. Further dose escalation is planned.     

Clinical outcome of stereotactic body radiotherapy of 54 Gy in nine fractions for patients with localized lung tumor using a custom-made immobilization system

Purpose The aim of this study was to investigate the clinical outcome of stereotactic body radiotherapy (SBRT) of 54 Gy in nine fractions for patients with localized lung tumor using a custom-made immobilization system. Methods and materials The subjects were 19 patients who had localized lung tumor (11 primaries, 8 metastases) between May 2003 and October 2005. Treatment was conducted on 19 lung tumors by fixed multiple noncoplanar conformal beams with a standard linear accelerator. The isocentric dose was 54 Gy in nine fractions. The median overall treatment time was 15 days (range 11–22 days). All patients were immobilized by a thermo-shell and a custom-made headrest during the treatment. Results The crude local tumor control rate was 95% during the follow-up of 9.4–39.5 (median 17.7) months. In-field recurrence was noted in only one patient at the last follow-up. The Kaplan-Meier overall survival rate at 2 years was 89.5%. Grade 1 radiation pneumonia and grade 1 radiation fibrosis were observed in 12 of the 19 patients. Treatment-related severe early and late complications were not observed in this series. Conclusion The stereotactic body radiotherapy of 54 Gy in nine fractions achieved acceptable tumor control without any severe complications. The results suggest that SBRT can be one of the alternatives for patients with localized lung tumors. Part of this work was presented at the 65th annual meeting of the Japan Radiological Society, April 2006     

Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

Purpose

To evaluate efficacy and toxicity of stereotactic body radiation therapy (SBRT) with CyberKnife® (Accuray, Sunnyvale, CA, USA) in a selected cohort of primary, medically inoperable early-stage non-small cell lung cancer (NSCLC) patients.

Methods

From 2012 to 2016, 106 patients (median age 74 years, range 50–94 years) with primary NSCLC were treated with SBRT using CyberKnife®. Histologic confirmation was available in 87 patients (82%). For mediastinal staging, 92 patients (87%) underwent ¹⁸F-fluorodeoxyglucose positron-emission tomography (18-FDG-PET) and/or endobronchial ultrasound (EBUS)-guided lymph node biopsy or mediastinoscopy. Tumor stage (UICC8, 2017) was IA/B (T1a-c, 1–3?cm) in 86 patients (81%) and IIA (T2a/b, 3–5?cm) in 20?patients (19%). Depending on tumor localization, three different fractionation schedules were used: 3 fractions of 17Gy, 5 fractions of 11Gy, or 8 fractions of 7.5?Gy. Tracking was based on fiducial implants in 13 patients (12%) and on image guidance without markers in 88%.

Results

Median follow-up was 15 months (range 0.5–46 months). Acute side effects were mild (fatigue grade 1–2 in 20% and dyspnea grade 1–2 in 17%). Late effects were observed in 4 patients (4%): 3 patients developed pneumonitis requiring therapy (grade 2) and 1 patient suffered a rib fracture (grade 3). In total, 9/106 patients (8%) experienced a local recurrence, actuarial local control rates were 88% (95% confidence interval, CI, 80–96%) at 2 years and 77% (95%CI 56–98%) at 3 years. The median disease-free survival time was 27 months (95%CI 23–31 months). Overall survival was 77% (95%CI 65–85%) at 2 years and 56% (95%CI 39–73%) at 3 years.

Conclusion

CyberKnife® lung SBRT which allows for real-time tumor tracking and risk-adapted fractionation achieves satisfactory local control and low toxicity rates in inoperable early-stage primary lung cancer patients.

     

立体定向适形放疗治疗原发性肝癌的近期疗效分析

目的 观察立体定向适形放疗治疗原发性肝癌的近期疗效.方法 28例原发性肝癌患者经Elscint twin flash 螺旋CT机定位后,用Leibinger三维放疗计划系统拟制放疗计划,在Varian直线加速器上实施治疗.平均随访时间为12个月.分析肿瘤反应率、放疗后无肝内肿瘤进展率及放疗后12个月生存率,观察治疗毒副作用.结果 放疗后肿瘤体积反应率为85.7%,放疗后12个月无肝内肿瘤进展率为38.4%,放疗后12个月生存率为70.5%.存活患者无晚期肝损伤.结论 立体定向适形放疗治疗肝癌的毒性较小,对提高肝内肿瘤的局部控制率有一定意义.