title: Application of robotic stereotactic radiotherapy to peripheral stage I non-small cell lung cancer with curative intent.
abstract: OBJECTIVE
  To determine the effectiveness of robotic stereotactic radiotherapy with image guidance and real-time respiratory tracking against early stage peripheral lung cancer.
  
  
  METHODS
  We treated patients with stage I non-small cell lung cancer (NSCLC) with CyberKnife and analysed their clinical characteristics and outcomes. All patients had co-morbid conditions that precluded lobectomy. The clinical target volume (CTV) included the gross tumour volume (GTV) and a 6mm margin in all directions to account for microscopic extension. The planning target volume (PTV) equalled CTV+2mm in all directions for uncertainty. Tumour motion was tracked using a combination of Synchrony and Xsight Spine tracking methods with the aid of a single gold marker implanted in the centre of the tumour, or using the newer Xsight Lung method without markers for selected tumours. A 60-67.5 Gy dose was prescribed to the 60-80% isodose line (median 65%) and given in three to five fractions. Patients were followed every 3 months for a median of 27.5 months (range 24-53 months).
  
  
  RESULTS
  Of the 67 patients with NSCLC stage IA or IB treated between January 2004 and December 2008, we report the results of a cohort of 31 with peripheral stage I tumours of 0.6-71 cm(3) volume treated between January 2004 and December 2007 with total doses between 60 and 67.5 Gy in three to five fractions. The median D(max) was 88.2 Gy and the median V(95) of the PTV was 99.6% or 27.9 cm(3). No grade 3 or above toxicity was encountered. Four cases of radiation pneumonitis and one case of oesophagitis were observed. In those patients whose pre- and post-treatment results were available, no change in pulmonary function tests was observed. Actuarial local control was 93.2% for 1 year and 85.8% for up to 4.5 years. One-year overall survival was 93.6% and 83.5% for up to 4.5 years, as projected by Kaplan-Meier analyses.
  
  
  CONCLUSIONS
  In this small cohort of patients with stage I peripheral NSCLC, robotic stereotactic radiotherapy seems to be a safe and obviously superior alternative to conventionally fractionated radiotherapy, with results that may be approaching those obtained with lobectomy without the associated morbidity.
authors.affiliation: CyberKnife Center of Miami, Miami, Florida, USA. brow5417@bellsouth.net
authors.forename: W T
authors.initials: WT
authors.lastname: Brown
authors.forename: X
authors.initials: X
authors.lastname: Wu
authors.forename: F
authors.initials: F
authors.lastname: Fayad
authors.forename: J F
authors.initials: JF
authors.lastname: Fowler
authors.forename: S
authors.initials: S
authors.lastname: García
authors.forename: M I
authors.initials: MI
authors.lastname: Monterroso
authors.forename: A
authors.initials: A
authors.lastname: de la Zerda
authors.forename: J G
authors.initials: JG
authors.lastname: Schwade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D012371:Robotics / Q000379:methods*; D016019:Survival Analysis