Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial.

BACKGROUND Stereotactic radiosurgery is well established for the treatment of intracranial neoplasms but its use for lung tumors is novel. METHODS Twenty-three patients with biopsy-proven lung tumors were recruited into a two-institution, dose-escalation, phase I clinical trial using a frameless stereotactic radiosurgery system (CyberKnife). Fifteen patients had primary lung tumors and 8 had metastatic tumors. The age range was 23 to 87 years (mean, 63 years). After undergoing computed tomography-guided percutaneous placement of two to four small metal fiducials directly into the tumor, patients received 1,500 cGY of radiation in a single fraction using a linear accelerator mounted on a computer-controlled robotic arm. Safety, feasibility, and efficacy were studied. RESULTS Nine patients were treated with a breath-holding technique, and 14 with a respiratory-gating, automated, robotic technique. Tumor size ranged from 1 to 5 cm in maximal diameter. There were four complications related to fiducial placement: three pneumothoraces requiring chest tube insertion and one emphysema exacerbation. There were no grade 3 to 5 radiation-related complications. Follow-up ranged from 1 to 26 months (mean, 7.0 months). Radiographic response was scored as complete in 2 patients, partial in 15, stable in 4, and progressive in 2. Four patients died of non-treatment-related causes at 1, 5, 9, and 11 months after radiation. CONCLUSIONS Single-fraction stereotactic radiosurgery is safe and feasible for the treatment of selected lung tumors. Additional studies are planned to investigate the optimal radiation dose, best motion-suppression technique, and overall treatment efficacy.

[1]  I. Lax,et al.  Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. , 1995, Acta oncologica.

[2]  J. Wong,et al.  Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. , 2001, International journal of radiation oncology, biology, physics.

[3]  M J Murphy,et al.  The Cyberknife: a frameless robotic system for radiosurgery. , 1997, Stereotactic and functional neurosurgery.

[4]  H. Withers.  Biologic basis for altered fractionation schemes , 1985, Cancer.

[5]  [Simple method of stereotactic radiotherapy without stereotactic body frame for extracranial tumors]. , 2001, Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica.

[6]  L V Rubinstein,et al.  Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. , 1995, The Annals of thoracic surgery.

[7]  G. Tsumatori,et al.  Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients , 1998, Cancer.

[8]  J Yorkston,et al.  A real-time, flat-panel, amorphous silicon, digital x-ray imager. , 1995, Radiographics : a review publication of the Radiological Society of North America, Inc.

[9]  Harvey I. Pass,et al.  Lung cancer : principles and practice , 1996 .

[10]  J R Adler,et al.  Clinical experience with image-guided robotic radiosurgery (the Cyberknife) in the treatment of brain and spinal cord tumors. , 1998, Neurologia medico-chirurgica.

[11]  Lohr Frank,et al.  Extracranial stereotactic conformal radiation treatment of tumors in the liver and the lung , 1998 .

[12]  L. Leksell.  The stereotaxic method and radiosurgery of the brain. , 1951, Acta chirurgica Scandinavica.

[13]  J. Adler,et al.  Robotic Motion Compensation for Respiratory Movement during Radiosurgery , 2000, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.