Treatment of early non-small cell lung cancer, stage IA, by image-guided robotic stereotactic radioablation--CyberKnife.
OBJECTIVE
To evaluate the efficacy of using image-guided robotic stereotactic radioablation as an alternative treatment modality for patients with surgically resectable, but medically inoperable, T1 N0 M0, stage IA non-small cell lung cancer.


METHODS
Between January 2004 and May 2006, 19 patients, 11 women and 8 men ranging in age from 52 to 88 years, with stage IA non-small cell lung cancer were treated. Tumor volume ranged from 1.7 to 13 mL. Total doses ranged from 24 to 60 Gy delivered in 3 fractions. Eleven patients received 60 Gy. Real-time target localization was accomplished by radiographic detection of fiducial marker(s) implanted within the tumor combined with respiratory motion tracking.


RESULTS
All patients tolerated radioablation well with fatigue as the main side effect. Fourteen patients are alive from 1 to 25 months posttreatment. Four patients died: 2 of comorbid disease and 2 of cancer progression (status post 60 and 55.5 Gy). Three patients developed grade I radiation pneumonitis. Two patients have stable disease. In 3 patients, cancer recurred in the planning treatment volume: in 2 patients after treatment with 60 Gy and in 1 patient after treatment with 55.5 Gy. One patient had local control in the target volume but developed metastasis to the ipsilateral hilum. Nine patients had a complete response and show no evidence of disease.


CONCLUSIONS
In our early experience, stereotactic radioablation using the CyberKnife system appears to be a safe, minimally invasive, and effective modality for treating early stage lung cancer in patients with medically inoperable disease. Dose escalation and/or increasing the treatment volumes, with the aid of the high conformality of this technique, may help to achieve further improvements in these promising results.
Brown
William T
WT
CyberKnife Center of Miami, Miami, FL 33156, USA.
Wu
Xiaodong
X
Amendola
Beatriz
B
Perman
Mark
M
Han
Hoke
H
Fayad
Fahed
F
Garcia
Silvio
S
Lewin
Alan
A
Abitbol
Andre
A
de la Zerda
Alberto
A
Schwade
James G
JG
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005221:Fatigue / Q000209:etiology; D005260:Female; D006046:Gold; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019736:Prostheses and Implants; D017564:Radiation Pneumonitis / Q000209:etiology; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome
D006046:Gold