title: Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy.
abstract: BACKGROUND
  To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy.
  
  
  METHODS
  Between April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8-16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy), and the median total dose was 49.5 Gy (range, 45-72 Gy). The median estimated biological effective dose at 10 Gy (BED10) was 71.8 Gy (range, 65.3-119.0 Gy), and that at 3 Gy (BED3) was 123.8 Gy (range, 112.5-233.3 Gy). The mean lung dose (MLD) was constrained mainly under 1200 cGy. The median gross tumor volume (GTV) was 27.9 cm3 (range: 2.5-178.1 cm3).
  
  
  RESULTS
  The median follow-up period was 25.8 months (range, 3.0-60.7 months). The median overall survival (OS) time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD) was 11.2 months versus >50 months (not reached) in the patients without EPD (p < 0.001). Those patients with smaller GTV (≦27.9 cm3) had a better survival than those with larger GTV (>27.9 cm3): >40 months versus 12.85 months (p = 0.047). The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065). The 2-year local control (LC) rate was 94.7%. Only 2 patients (6.1%) developed ≧grade 3 radiation pneumonitis.
  
  
  CONCLUSIONS
  Using Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with EPD. Moreover, GTV is more significant than lesion number in predicting survival.
authors.affiliation: Department of Radiation Therapy and Oncology, Shin-Kong Wu Ho-Su Memorial Hospital, 95, Wen-Chang Road, Shih-Lin, Taipei City, Taiwan.
authors.forename: Heng-Jui
authors.initials: HJ
authors.lastname: Chang
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Ko
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Lee
authors.forename: Ren-Hong
authors.initials: RH
authors.lastname: Wu
authors.forename: Yu-Wung
authors.initials: YW
authors.lastname: Yeh
authors.forename: Jiunn-Song
authors.initials: JS
authors.lastname: Jiang
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Kao
authors.forename: Kwan-Hwa
authors.initials: KH
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome