title: Hypofractionated stereotactic radiotherapy for primary and secondary intrapulmonary tumors: first results of a phase I/II study.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Therapy and Novalis Shaped Beam Surgery Center, University Hospital Erlangen, Erlangen, Germany. antje.ernst-stecken@strahlen.imed.uni-erlangen.de
authors.forename: Antje
authors.initials: A
authors.lastname: Ernst-Stecken
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lambrecht
authors.forename: Reinhold
authors.initials: R
authors.lastname: Mueller
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Grabenbauer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000295:instrumentation; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D016634:Radiosurgery / Q000295:instrumentation*; D016019:Survival Analysis; D016896:Treatment Outcome