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Clinical outcomes of 130 patients with primary and secondary lung tumors treated with Cyberknife robotic stereotactic body radiotherapy

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Radiology and Oncology

Volume 51 (2017): Numero 2 (June 2017)

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Article Category: Research Articles

Pubblicato online: 03 apr 2017

Pagine: 178 - 186

Ricevuto: 15 dic 2016

Accettato: 27 feb 2017

DOI: https://doi.org/10.1515/raon-2017-0015

© 2017 Zsolt Levente Janvary, Nicolas Jansen, Veronique Baart, Magali Devillers, David Dechambre, Eric Lenaerts, Laurence Seidel, Nicole Barthelemy, Patrick Berkovic, Akos Gulyban, Ferenc Lakosi, Zsolt Horvath, Philippe A. Coucke

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Probabilty of local control according to dose (BED ≥112.5 Gy vs. higher).

Probability of local control for primary (n = 86), recurrent (n = 35) and metastatic (n = 39) lesions.

Probability of local control for peripheral (n = 113) and central (n = 47) lesions.

Dose constraints for organs at risk

Organ	Type of constraint	Dose(Gy) for 3 fractions SBRT	Dose (Gy) for 5 fractions SBRT
Spinal cord	D_max	22 (7.33 Gy/fx)	30 (6 Gy/fx)
Esophagus	D_max	27 (9 Gy/fx)	35 (7 Gy/fx)
Trachea and main bronchi	D_max	30 (10 Gy/fx)	32 (6.4 Gy/fx)
Heart	D_max	30 (10 Gy/fx)	38 (7.6 Gy/fx)
Plexus brachialis	D_max	24 (8 Gy/fx)	32 (6.4 Gy/fx)
Ribs	D_max	37 (12.3/fx)	43 (8.6/fx)
Skin	D_max	32 (10.6/fx)	24 (4.8/fx)
Lung (both lungs)	Volumetric	V_10.5Gy <1500 cc	V_12.5Gy <1500 cc
Lung (both lungs)	Volumetric	V_11.4Gy <1000 cc	V_13.5Gy <1000 cc
Liver	Volumetric	V_17.1Gy <700 cc	V_21Gy <700 cc

Dose-fractionation schemes

Radiotherapy scheme	BED_10Gy(Gy)	n (%)
3×20 Gy	180	96 (60%)
3×18 Gy	151.2	7 (4%)
3×17 Gy	137.7	4 (2.5%)
5×12 Gy	132	1 (0,6%)
3×15 Gy	112.5	24 (15%)
5×10 Gy	100	4 (2.5%)
5×9 Gy	85.5	11 (7%)
5×8 Gy	72	13 (8%)

Comparative table of relevant published data and own results

Study	Technic	Histological confirmation %	No. of pts/ lesions	dose (Gy)/fx	BED_10Gy (Gray)	Median FUP (month)	Local Control	Overall Survival

PRIMARY
Chen VJ (26)	CK	100	40	median 48 (42-60)/3 fx	124.8	44	91%@3y	75%@3y
van der Voort	CK	51	70	60/3fx (Peripheral)	180 (Peripheral)	15	96%@2y for 60 Gy	62%@2y
van Zyp (27)				45/3fx (Central)	112.5 (Central)		78%@2y for 45 Gy
Factor (28)	CK	95	78	68/4 fx (Peripheral)	75-180	14.4	87%@2y	68%@2y
				48/4 fx (Central)
Bahig (4)	CK	84	150	median 60/3 fx	72-180 (Peripheral)	22	96%2y	87%2y
				40-60/3-5 fx	106-180 (Central)
Shen (29)	CK	84	50	57 (48-60)/3fx	104-150	35	crude 96%@2y	86%@1y
								74%@2y
Davis, RSS REGISTRY (5)	CK,LINAC	100	723/741	median 54 (10-80)/3 fx	151.2	12	88%@1y	T1: 85/63%@1/2y
							76%@2y	T2: 76/52@1y/2y
Fakiris (30)	LINAC	100	70	60-66/3fx	180-211.2	50.2	88.1%@3y	42.7%@3y

METASTASES

Nuyttens (7)	CK	12	30/57	30/1 fx; 60/3-5 fx; 56/7 fx		36	79%@1y	38%@2y
Inoue (8)	LINAC		87/189	48/3fx; 50/5 fx; 52-60/10 fx;	30-168		80%@2y	47%@2y
							80%@3y	32%%@3y

MIXED: PRIMARY+METASTASES

Guckenberger (31)	LINAC	19	124/159	26/1 fx; 37.5/3; 48/8 fx		14	83%@3y	37%@3y (Primary)
								16%@3y (Met)
Ernst-Stecken (9)	LINAC	100	21/39	35-40/5 fx	59.5-72	6.3	crude: 87%	crude: 86%
					84 (Peripheral)		80.5%@2y	52.7%@2y
Duncker-Rohr (32)	LINAC	55	39/45	37.5/3 fx; 30/5 fx	60 (Central)	17	95% @2y Prim	45.9% (Primary)
							59.7%@2y Met	66.7% (Met)
		total 61%		median 60/3 fx (Peripheral)	median 180 (Peripheral)		86%@1y
Current study	CK	primary 77%		median 45/5 fx (Central)	median 112.5 (Central)	21	75%@2y
							62 %@3y

Patient, tumor and treatment characteristcs

Characteristic	n (%)
Total number of patients/lesions	130 (100%)/160 (100%)
Mean age in years	71 (range: 40–92)
Male/female ratio	77 (59%) / 53 (41%)
No. with COPD	45 (35%)
Mean FEV1 (%)	65 (range: 24–139)
Mean FEV1 (L)	2 (range: 0.53–3.65)
Histological confirmation	79 (61%)
Primary cancer patients/lesions	81 (62%) / 86 (54%)
T1N0	53
T2N0	19
T3N0	5
T1N1	4
Recurrent tumor patients /lesions (n)	23 (18%) / 35 (22%)
Lung metastasis patients /lesions (n)	26 (20%) / 39 (24%)
Mean GTV volume (ml)	11.5 (range: 0.6–86.5)
Mean PTV volume (ml)	33.2 (range: 5.8–118.1)
Location of lesions: peripheral/central	113 (71%) /47 (29%)
Mean total dose (Gy)/Mean no. of fractions	60/3 fx (range: 40–60 / 3–5 fx)
Mean/median BED_10Gy(Gy)	151/180 Gy

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