title: Dosimetric evaluation of the feasibility of stereotactic body radiotherapy for primary lung cancer with lobe-specific selective elective nodal irradiation.
abstract: More than 10% of all patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer develop regional lymph node recurrence. We evaluated the dosimetric feasibility of SBRT with lobe-specific selective elective nodal irradiation (ENI) on dose-volume histograms. A total of 21 patients were treated with SBRT for Stage I primary lung cancer between January 2010 and June 2012 at our institution. The extents of lobe-specific selective ENI fields were determined with reference to prior surgical reports. The ENI fields included lymph node stations (LNS) 3 + 4 + 11 for the right upper lobe tumors, LNS 7 + 11 for the right middle or lower lobe tumors, LNS 5 + 11 for the left upper lobe tumors, and LNS 7 + 11 for the left lower lobe tumors. A composite plan was generated by combining the ENI plan and the SBRT plan and recalculating for biologically equivalent doses of 2 Gy per fraction, using a linear quadratic model. The V20 of the lung, D(1cm3) of the spinal cord, D(1cm3) and D(10cm3) of the esophagus and D(10cm3) of the tracheobronchial wall were evaluated. Of the 21 patients, nine patients (43%) could not fulfill the dose constraints. In all these patients, the distance between the planning target volume (PTV) of ENI (PTVeni) and the PTV of SBRT (PTVsrt) was ≤2.0 cm. Of the three patients who developed regional metastasis, two patients had isolated lymph node failure, and the lymph node metastasis was included within the ENI field. When the distance between the PTVeni and PTVsrt is >2.0 cm, SBRT with selective ENI may therefore dosimetrically feasible.
authors.affiliation: Department of Radiation Oncology, Tokai University School of Medicine komat@tokai-u.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Komatsu
authors.affiliation: Department of Radiation Oncology, Tokai University School of Medicine.
authors.forename: Etsuo
authors.initials: E
authors.lastname: Kunieda
authors.affiliation: Department of Radiation Oncology, Tokai University School of Medicine.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitahara
authors.affiliation: Department of Radiation Oncology, Tokai University School of Medicine.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: Department of Radiation Oncology, Tokai University School of Medicine.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Nagao
authors.affiliation: Department of Radiation Oncology, Tokai University School of Medicine.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fukuzawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity / Q000528:radiation effects; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
keywords: dose–volume histogram; elective nodal irradiation; primary lung cancer; stereotactic body radiotherapy