Original Article

Lung Metastases Treated by CyberKnife® Image-Guided Robotic Stereotactic Radiosurgery at 41 Months

Authors: William T. Brown, MD, Xiaodong Wu, PhD, John F. Fowler, DSc, PhD, Silvio García, MD, Fahed Fayad, MD, Beatriz E. Amendola, MD, Alberto de la Zerda, PhD, James G. Schwade, MD

Abstract

Objectives: Based on the reported success of stereotactic body radiotherapy in treating extracranial tumors, we used CyberKnife® (Accuray Incorporated, Sunnyvale, CA) to treat patients with metastatic lung cancer.


Methods: This is a retrospective report of treatment details and outcomes of 35 patients, ranging in age from 33 to 91 years, with 69 histologically proven pulmonary metastases, treated by image-guided robotic stereotactic radiosurgery at the CyberKnife® Center of Miami, between March 2004 and August 2007. Tumor volumes ranged from 0.7 mL to 152 mL. Total doses ranged from 5 to 60 Gy delivered in one to four fractions with an equivalent dose range from 6 to 110 Gy NTD delivered in 2-Gy fractions assuming an α/β of 20 Gy.


Results: All patients tolerated radiosurgery well with fatigue as the main side effect. Grade 3 and grade 4 pulmonary toxic reactions were observed in one patient who had undergone a repeat treatment. Of the 35 treated patients, 27 (77%) were still alive at a median 18-month (range 2–41 mo) follow-up. Local control was 71% with 25 tumors showing a complete response, 16 a partial response, and 7 stable with disease. Eight had progressive disease.


Conclusions: The delivery of precisely targeted radiation doses to lung tumors in a hypofractionated fashion is feasible and safe. image-guided robotic stereotactic radiosurgery of pulmonary metastases with the CyberKnife® achieves good rates of local disease control with limited toxicity to surrounding tissues and in many cases may be beneficial for patients for whom surgery is not an option.


Key Points


* Image-guided stereotactic radiosurgery provides an option for patients with resectable but medically inoperable metastatic lung tumors.


* In patients with limited pulmonary metastases, potent doses of image-guided robotic stereotactic radiosurgical system (IGR-SRS) are well tolerated with limited early toxicity.


* Local control rates are better than those obtained with conventional radiotherapy.


* Systematic research is necessary to clearly establish optimal treatment parameters.

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