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Okonogi N, Kaminuma T, Okimoto T, Shinoto M, Yamamoto N, Yamada S, Murata K, Ohno T, Shioyama Y, Tsuji H, Nakano T, Kamada T. Carbon-ion radiotherapy for lymph node oligo-recurrence: a multi-institutional study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS). Int J Clin Oncol 2019; 24:1143-1150. [PMID: 30968270 PMCID: PMC6687700 DOI: 10.1007/s10147-019-01440-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023]
Abstract
Background The efficacy of carbon-ion radiotherapy (C-ion RT) for lymph node (LN) oligo-recurrence has only been evaluated in limited single-center studies. We aimed to investigate the benefit of C-ion RT for LN oligo-recurrence in a large multi-center study. Methods Patients who received C-ion RT between December 1996 and December 2015 at 4 participating facilities and who met the following eligibility criteria were included: (i) histological or clinical diagnosis of LN recurrence; (ii) controlled primary lesion; (iii) no recurrence other than LN; (iv) LN recurrence involved in a single lymphatic site; and (v) age ≥ 20 years. Results A total of 323 patients were enrolled. Median follow-up period was 34 months for surviving patients. The most common dose fractionation of C-ion RT was 48.0 Gy (relative biological effectiveness) in 12 fractions. Forty-seven patients had a history of RT at the recurrent site. The 2-year local control (LC) and overall survival (OS) rates after C-ion RT were 85% and 63%, respectively. Only 1 patient developed grade-3 toxicity. Factors such as LN diameter, histology, and history of previous RT did not correlate with LC. Smaller diameters (< 30 mm) and numbers (≤ 3) of LN metastases as well as longer disease-free intervals post-primary therapy (≥ 16 months) were associated with significantly better OS. Conclusions C-ion RT for LN oligo-recurrence appeared to be effective and safe. C-ion RT may provide a survival benefit to patients with LN oligo-recurrence, particularly to those with few LN metastases, smaller LN diameters, and longer disease-free intervals. Electronic supplementary material The online version of this article (10.1007/s10147-019-01440-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Makoto Shinoto
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Saga, Japan
| | - Naoyoshi Yamamoto
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Kamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
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Li S, Yang J, Liu J, Gao S, Liu B, Yan J. Dosimetric comparison of helical tomotherapy and conventional Linac-based X-knife stereotactic body radiation therapy for primary lung cancer or pulmonary metastases. J Thorac Dis 2018; 10:999-1006. [PMID: 29607173 DOI: 10.21037/jtd.2018.01.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background To compare helical tomotherapy (HT) with X-knife stereotactic body radiation therapy (HT-SBRT/X-SBRT) for primary or metastatic lung cancer regarding planning target volume (PTV) coverage, such as homogeneity index (HI), conformity index (CI) and dose-volume histogram (DVH) of organs at risk (OARs). Methods We retrospectively analyzed 21 patients receiving definitive radiation treatment for non-small cell lung cancer (NSCLC) or pulmonary metastases at our institution between March 2015 and October 2016. Tumors were irradiated with 4-10 Gy per fraction in 5-15 fractions. Plans were compared according to PTV coverage and OARs sparing. Results Significant differences between HT and X-knife were observed for both HI (P=0.003) and CI (P<0.001). The V5 (P=0.001), V10 (P=0.009), V20 (P=0.001), the mean lung dose (P=0.005) of total lung and maximum dose of the spinal cord (P=0.010) were significantly lower in the X-SBRT group than the HT-SBRT group. There were no significant differences for the V30 (P=0.075) and the mean heart dose (P=0.584) between the two groups. Conclusions X-SBRT was dosimetrically superior to HT-SBRT, when applied in these tumors' maximum diameters <5 cm. As HT resulted in increased low-dose volume, it is essential to optimize the patient selection in order to avoid severe radiation pneumonitis in HT-SBRT.
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Affiliation(s)
- Shuangshuang Li
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - Ju Yang
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - Juan Liu
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - Shanbao Gao
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - Baorui Liu
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - Jing Yan
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
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Figlia V, Mazzola R, Cuccia F, Alongi F, Mortellaro G, Cespuglio D, Cucchiara T, Iacoviello G, Valenti V, Molino M, Verderame F, Matranga D, Casto AL, Ferrera G. Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience. Radiol Med 2018; 123:406-414. [PMID: 29455424 DOI: 10.1007/s11547-018-0858-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several experiences in the literature report SBRT as an effective treatment option for medically inoperable early stage non-small cell lung cancer (NSCLC) and oligometastatic disease. The optimal fractionation schedules and total dose remain controversial. In this study, we evaluated the safety in terms of toxicity and efficacy of using of 8-10 fractions schedules with Helical Tomotherapy (HT) for primary and metastatic lung lesions. METHODS Between March 2014 and May 2016, a total of 39 patients (median age 72 years, range 26-91) were treated with HT-SBRT for malignant lung lesions: 22 patients with early stage NSCLC, 17 with oligometastases. Patients received 8-10 fractions with lower daily dose for central and ultracentral lesions. Treatment-related toxicity was evaluated using CTCAE v 4.0 scale. Local control (LC), overall survival (OS) and toxicity rates were prospectively collected. RESULTS Median duration of RT was 15 days (range 10-26 days) and no interruption occurred. With a median follow-up of 13 months (range 3-29), we reported one G2 pneumonitis (2.6%) and one G2 chest pain (2.6%); no ≥ G2 esophagitis was registered. Actuarial local control rate was 95.5% both at 12 and 24 months for early stage NSCLC and 92.9% both at 12 and 24 months for metastatic patients. OS rate was 94.4 and 92.3% at 1 year, and 94.4 and 83.9% at 2 years in primary and metastatic group, respectively. CONCLUSIONS The use of 8-10 fractions schedule HT-SBRT for lung malignancies results in high LC and OS rates with minimal toxicities reported.
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Affiliation(s)
- Vanessa Figlia
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Rosario Mazzola
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
| | - Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy.
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
- University of Brescia, Brescia, Italy
| | | | | | | | | | - Vito Valenti
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Massimo Molino
- Radiology Department, ARNAS-Civico Hospital, Palermo, Italy
| | | | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Giuseppe Ferrera
- Statistic Science Faculty, University of Palermo, Palermo, Italy
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Arcangeli S, Falcinelli L, Bracci S, Greco A, Monaco A, Dognini J, Chiostrini C, Bellavita R, Aristei C, Donato V. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours. Br J Radiol 2017; 90:20160853. [PMID: 28256158 PMCID: PMC5601537 DOI: 10.1259/bjr.20160853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/16/2017] [Accepted: 01/24/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. METHODS 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume. 52% of the lesions received a biological equivalent dose (BED10) ≥100 Gy. Assessment of tumour response was based on the Response Evaluation Criteria in Solid Tumours 1.1 criteria coupled with fluorine-18 fludeoxyglucose/positron emission tomography-CT. Toxicity monitoring was focused on treatment-related pulmonary adverse events according to the Common Terminology Criteria for Adverse Events v. 4.0. Acute and late events were classified as radiation pneumonitis (RP) and radiation fibrosis (RF), respectively. Survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate analyses of survival were performed using the Cox proportional hazards model. RESULTS After a median follow-up of 12 months (range, 3-31 months), no instances of ≥Grade 4 RP was documented, and clinically severe (Grade 3) RP occurred in 5.8% of the patients. 2 (3%) patients developed a late severe (≥Grade 3) symptomatic RF. No specific pattern of CT lung injury was demonstrated, in both acute and late settings. Median overall survival (OS) and progression-free survival (PFS) for the entire population were 30.8 and 14.1 months, respectively. At multivariate analysis (MVA), BED10 ≥ 100 Gy and KPS ≥ 90 emerged as significant prognostic factors for OS (p = 0.01 and p = 0.001, respectively), and BED10 ≥ 100 Gy for PFS (p = 0.02). CONCLUSION Our findings show that HHT adjusted for tumour location and/or target volume is an effective treatment with an acceptable toxicity profile in patients who are medically inoperable with lung tumours and is not associated with a specific pattern of lung injury. Therefore, it can represent a viable option when conventional stereotactic ablative radiotherapy facilities are not available. Advances in knowledge: The present study is among the largest series addressing the role of HHT for inoperable lung tumours. This technique is safe and effective and is not associated with a specific pattern of lung injury, at least at early and average time points.
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Affiliation(s)
- Stefano Arcangeli
- Department of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
| | - Lorenzo Falcinelli
- Department of Radiation Oncology, S. Maria della Misericordia University Hospital, Perugia, Italy
| | - Stefano Bracci
- Department of Radiation Oncology, S. Andrea University Hospital, Rome, Italy
| | - Alessandro Greco
- Department of Radiation Oncology, S. Andrea University Hospital, Rome, Italy
| | - Alessia Monaco
- Department of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
| | - Jessica Dognini
- Department of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
| | - Cinzia Chiostrini
- Department of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
| | - Rita Bellavita
- Department of Radiation Oncology, S. Maria della Misericordia University Hospital, Perugia, Italy
| | - Cynthia Aristei
- Department of Radiation Oncology, S. Maria della Misericordia University Hospital, Perugia, Italy
| | - Vittorio Donato
- Department of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
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Spanish Society of Radiation Oncology clinical guidelines for stereotactic body radiation therapy in lymph node oligometastases. Clin Transl Oncol 2015; 18:342-51. [PMID: 26329294 DOI: 10.1007/s12094-015-1383-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/08/2015] [Indexed: 02/06/2023]
Abstract
Data in the literature support the existence of a state of limited metastases or oligometastases. Favorable outcomes have been observed in selected patients with such oligometastases that are treated with local ablative therapies, which include surgical extirpation, stereotactic body radiation therapy (SBRT), and radiofrequency ablation. The role of SBRT in the setting of lymph node oligometastases is still emerging but the early results for local control are promising. However, the biggest challenge is to identify patients who will benefit from treatment of their oligometastatic disease with local aggressive therapy. Patients are initially categorized based upon examination of the initial biopsy, location, stage, and previous treatments received. Appropriate patient management with SBRT requires an understanding of several clinicopathological features that help to identify several subsets of patients with more responsive tumors and a good tolerance to SBRT. In an effort to incorporate the most recent evidence, here the Spanish Society of Radiation Oncology presents guidelines for using SBRT in lymph node oligometastases.
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Arcangeli S, Agolli L, Portalone L, Migliorino MR, Lopergolo MG, Monaco A, Dognini J, Pressello MC, Bracci S, Donato V. Patterns of CT lung injury and toxicity after stereotactic radiotherapy delivered with helical tomotherapy in early stage medically inoperable NSCLC. Br J Radiol 2015; 88:20140728. [PMID: 25645106 PMCID: PMC4651249 DOI: 10.1259/bjr.20140728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/28/2015] [Accepted: 02/02/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate toxicity and patterns of radiologic lung injury on CT images after hypofractionated image-guided stereotactic body radiotherapy (SBRT) delivered with helical tomotherapy (HT) in medically early stage inoperable non-small-cell lung cancer (NSCLC). METHODS 28 elderly patients (31 lesions) with compromised pulmonary reserve were deemed inoperable and enrolled to undergo SBRT. Patterns of lung injury based on CT appearance were assessed at baseline and during follow up. Acute (6 months or less) and late (more than 6 months) events were classified as radiation pneumonitis and radiation fibrosis (RF), respectively. RESULTS After a median follow-up of 12 months (range, 4-20 months), 31 and 25 lesions were examined for acute and late injuries, respectively. Among the former group, 25 (80.6%) patients showed no radiological changes. The CT appearance of RF revealed modified conventional, mass-like and scar-like patterns in three, four and three lesions, respectively. No evidence of late lung injury was demonstrated in 15 lesions. Five patients developed clinical pneumonitis (four patients, grade 2 and one patient, grade 3, respectively), and none of whom had CT findings at 3 months post-treatment. No instance of symptomatic RF was detected. The tumour response rate was 84% (complete response + partial response). Local control was 83% at 1 year. CONCLUSION Our findings show that HT-SBRT can be considered an effective treatment with a mild toxicity profile in medically inoperable patients with early stage NSCLC. No specific pattern of lung injury was demonstrated. ADVANCES IN KNOWLEDGE Our study is among the few showing that HT-SBRT represents a safe and effective option in patients with early stage medically inoperable NSCLC, and that it is not associated with a specific pattern of lung injury.
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Affiliation(s)
- S Arcangeli
- 1 Department of Radiotherapy, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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Martin AGR, Thomas SJ, Harden SV, Burnet NG. Evaluating competing and emerging technologies for stereotactic body radiotherapy and other advanced radiotherapy techniques. Clin Oncol (R Coll Radiol) 2015; 27:251-9. [PMID: 25727646 DOI: 10.1016/j.clon.2015.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/09/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Stereotactic body radiotherapy (SBRT) refers to the precise irradiation of an image-defined extracranial lesion, using a high total radiation dose delivered in a small number of fractions. A significant proportion of SBRT treatment has been successfully delivered using conventional gantry-based linear accelerators with appropriate image guidance and motion management techniques, although a number of specialist systems are also available. Evaluating the competing SBRT technologies is difficult due to frequent refinements to all major platforms. Comparison of geometric accuracy or treatment planning performance can be hard to interpret and may not provide much useful information. Nevertheless, a general specification overview can provide information that may help radiotherapy providers decide on an appropriate system for their centre. A number of UK randomised controlled trials (RCTs) have shown that better radiotherapy techniques yield better results. RCTs should play an important part in the future evaluation of SBRT, especially where there is a smaller volume of existing data, and where outcomes from conventional radiotherapy are very good. RCT comparison of SBRT with surgery is more difficult due to the radically different treatment arms, although successful recruitment can be possible if the lessons from previous failed trials are learned. The evaluation of new technology poses a number of challenges to the conventional RCT methodology, and there may be situations where it is genuinely not possible, with careful observational studies or decision modelling being more appropriate. Further development in trial design may have an important role in providing clinical evidence in a more timely manner.
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Affiliation(s)
- A G R Martin
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S J Thomas
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S V Harden
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N G Burnet
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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Florescu C, Thariat J. Local ablative treatments of oligometastases from head and neck carcinomas. Crit Rev Oncol Hematol 2014; 91:47-63. [PMID: 24556572 DOI: 10.1016/j.critrevonc.2014.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Median survival for recurrent/metastatic (unknown poly/oligometastatic status) head and neck cancer patients (HNSCC) is ten months with best systemic treatment. Metastatic ablation shows promising results in selected patients with several tumor types. We aimed to assess the role of surgery and stereotactic ablative body radiotherapy (SABR) with respect to survival in HNSCC. MATERIALS AND METHODS Published data on metastatic HNSCC treated ablatively were analyzed. RESULTS Five-year survival rates after pulmonary/liver metastasectomy exceed 20% in selected patients. Two-year survival after lung SABRT of metastasectomy yields 35%. Interesting data on survival and tolerance are reported in other metastatic sites. CONCLUSION Surgery yields the best level of evidence. However, non-invasive SABR is efficient and well-tolerated in lung/liver, bone and other metastatic locations. Systemic treatment may be given sequentially with ablative treatments, or omitted in well-identified situations. Proper patient selection for local ablative treatment and optimal therapeutic sequence should be assessed in randomized trials.
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Affiliation(s)
- C Florescu
- Service de Radiothérapie, Centre Fran¸cois Baclesse, Avenue Général Harris, 14076, Caen, France
| | - J Thariat
- Centre Antoine Lacassagne - Université de Nice Sophia Antipolis, 227 Av de la lanterne, 06200, Nice, France.
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