Intensity-modulated stereotactic radiotherapy for the treatment of medically             inoperable patients with NSCLC stage I.
The standard treatment for stage I non-small cell lung cancer (NSCLC) is             lobectomy. However, a considerable number of patients are not eligible for standard             lung surgery due to poor pulmonary function or comorbidities. We evaluated the             efficacy and tolerability of intensity-modulated stereotactic radiotherapy (IMSRT)             with moderate hypofractionation for these patients. Twelve patients were selected             for IMSRT. 4D-CT planning was performed by gating CT-scanning positioning. The             applied doses ranged between 10x4.5 Gy (80% ID) (N=1), 12x4.5 Gy (95% ID) (N=1)             and 10x5.5 Gy (95% ID) (N=10). Long-term follow-up was performed including spirometry             and CT for evaluation of local, locoregional and distant control. Even in patients             with poor pulmonary function IMRST was safe and well tolerated. No severe acute             adverse effects were observed. Estimated local control at 2 years was 90%. Moreover,             IMSRT does not induce a significant deterioration of pulmonary function. IMRST             is safe and feasible even for patients with very poor pulmonary function. The             applied dose provides a high local control rate, although the biological equivalent             dose (BED) is lower compared to the average of other SRT regimens. Therefore,             IMRST may be an efficient alternative for all NSCLC stage I patients with contraindications             to standard lobectomy especially in patients with small tumors in high-risk localisations.
Department of Radiation Oncology, University Hospital, D-72076 Tübingen, Germany.
Stephan
S
Lächelt
Markus
M
Alber
Matthias
M
Söhn
Michael
M
Bamberg
Volker
V
Steger
Martin
M
Weinmann
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012371:Robotics; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome