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CyberKnife for hilar lung tumors: report of clinical response and toxicity

OBJECTIVE: To report clinical efficacy and toxicity of fractionated CyberKnife radiosurgery for the treatment of hilar lung tumors. METHODS: Patients presenting with primary and metastatic hilar lung tumors, treated using the CyberKnife system with Synchrony fiducial tracking technology, were retros...

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Autores principales: Unger, Keith, Ju, Andrew, Oermann, Eric, Suy, Simeng, Yu, Xia, Vahdat, Saloomeh, Subramaniam, Deepa, William Harter, K, Collins, Sean P, Dritschilo, Anatoly, Anderson, Eric, Collins, Brian T
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987864/
https://www.ncbi.nlm.nih.gov/pubmed/20969774
http://dx.doi.org/10.1186/1756-8722-3-39
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author Unger, Keith
Ju, Andrew
Oermann, Eric
Suy, Simeng
Yu, Xia
Vahdat, Saloomeh
Subramaniam, Deepa
William Harter, K
Collins, Sean P
Dritschilo, Anatoly
Anderson, Eric
Collins, Brian T
author_facet Unger, Keith
Ju, Andrew
Oermann, Eric
Suy, Simeng
Yu, Xia
Vahdat, Saloomeh
Subramaniam, Deepa
William Harter, K
Collins, Sean P
Dritschilo, Anatoly
Anderson, Eric
Collins, Brian T
author_sort Unger, Keith
collection PubMed
description OBJECTIVE: To report clinical efficacy and toxicity of fractionated CyberKnife radiosurgery for the treatment of hilar lung tumors. METHODS: Patients presenting with primary and metastatic hilar lung tumors, treated using the CyberKnife system with Synchrony fiducial tracking technology, were retrospectively reviewed. Hilar location was defined as abutting or invading a mainstem bronchus. Fiducial markers were implanted by conventional bronchoscopy within or adjacent to tumors to serve as targeting references. A prescribed dose of 30 to 40 Gy to the gross tumor volume (GTV) was delivered in 5 fractions. Clinical examination and PET/CT imaging were performed at 3 to 6-month follow-up intervals. RESULTS: Twenty patients were accrued over a 4 year period. Three had primary hilar lung tumors and 17 had hilar lung metastases. The median GTV was 73 cc (range 23-324 cc). The median dose to the GTV was 35 Gy (range, 30 - 40 Gy), delivered in 5 fractions over 5 to 8 days (median, 6 days). The resulting mean maximum point doses delivered to the esophagus and mainstem bronchus were 25 Gy (range, 11 - 39 Gy) and 42 Gy (range, 30 - 49 Gy), respectively. Of the 17 evaluable patients with 3 - 6 month follow-up, 4 patients had a partial response and 13 patients had stable disease. AAT t a median follow-up of 10 months, the 1-year Kaplan-Meier local control and overall survival estimates were 63% and 54%, respectively. Toxicities included one patient experiencing grade II radiation esophagitis and one patient experiencing grade III radiation pneumonitis. One patient with gross endobronchial tumor within the mainstem bronchus developed a bronchial fistula and died after receiving a maximum bronchus dose of 49 Gy. CONCLUSION: CyberKnife radiosurgery is an effective palliative treatment option for hilar lung tumors, but local control is poor at one year. Maximum point doses to critical structures may be used as a guide for limiting toxicities. Preliminary results suggest that dose escalation alone is unlikely to enhance the therapeutic ratio of hilar lung tumors and novel approaches, such as further defining the patient population or employing the use of radiation sensitizers, should be investigated.
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spelling pubmed-29878642010-11-19 CyberKnife for hilar lung tumors: report of clinical response and toxicity Unger, Keith Ju, Andrew Oermann, Eric Suy, Simeng Yu, Xia Vahdat, Saloomeh Subramaniam, Deepa William Harter, K Collins, Sean P Dritschilo, Anatoly Anderson, Eric Collins, Brian T J Hematol Oncol Short Report OBJECTIVE: To report clinical efficacy and toxicity of fractionated CyberKnife radiosurgery for the treatment of hilar lung tumors. METHODS: Patients presenting with primary and metastatic hilar lung tumors, treated using the CyberKnife system with Synchrony fiducial tracking technology, were retrospectively reviewed. Hilar location was defined as abutting or invading a mainstem bronchus. Fiducial markers were implanted by conventional bronchoscopy within or adjacent to tumors to serve as targeting references. A prescribed dose of 30 to 40 Gy to the gross tumor volume (GTV) was delivered in 5 fractions. Clinical examination and PET/CT imaging were performed at 3 to 6-month follow-up intervals. RESULTS: Twenty patients were accrued over a 4 year period. Three had primary hilar lung tumors and 17 had hilar lung metastases. The median GTV was 73 cc (range 23-324 cc). The median dose to the GTV was 35 Gy (range, 30 - 40 Gy), delivered in 5 fractions over 5 to 8 days (median, 6 days). The resulting mean maximum point doses delivered to the esophagus and mainstem bronchus were 25 Gy (range, 11 - 39 Gy) and 42 Gy (range, 30 - 49 Gy), respectively. Of the 17 evaluable patients with 3 - 6 month follow-up, 4 patients had a partial response and 13 patients had stable disease. AAT t a median follow-up of 10 months, the 1-year Kaplan-Meier local control and overall survival estimates were 63% and 54%, respectively. Toxicities included one patient experiencing grade II radiation esophagitis and one patient experiencing grade III radiation pneumonitis. One patient with gross endobronchial tumor within the mainstem bronchus developed a bronchial fistula and died after receiving a maximum bronchus dose of 49 Gy. CONCLUSION: CyberKnife radiosurgery is an effective palliative treatment option for hilar lung tumors, but local control is poor at one year. Maximum point doses to critical structures may be used as a guide for limiting toxicities. Preliminary results suggest that dose escalation alone is unlikely to enhance the therapeutic ratio of hilar lung tumors and novel approaches, such as further defining the patient population or employing the use of radiation sensitizers, should be investigated. BioMed Central 2010-10-22 /pmc/articles/PMC2987864/ /pubmed/20969774 http://dx.doi.org/10.1186/1756-8722-3-39 Text en Copyright ©2010 Unger et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Short Report
Unger, Keith
Ju, Andrew
Oermann, Eric
Suy, Simeng
Yu, Xia
Vahdat, Saloomeh
Subramaniam, Deepa
William Harter, K
Collins, Sean P
Dritschilo, Anatoly
Anderson, Eric
Collins, Brian T
CyberKnife for hilar lung tumors: report of clinical response and toxicity
title CyberKnife for hilar lung tumors: report of clinical response and toxicity
title_full CyberKnife for hilar lung tumors: report of clinical response and toxicity
title_fullStr CyberKnife for hilar lung tumors: report of clinical response and toxicity
title_full_unstemmed CyberKnife for hilar lung tumors: report of clinical response and toxicity
title_short CyberKnife for hilar lung tumors: report of clinical response and toxicity
title_sort cyberknife for hilar lung tumors: report of clinical response and toxicity
topic Short Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987864/
https://www.ncbi.nlm.nih.gov/pubmed/20969774
http://dx.doi.org/10.1186/1756-8722-3-39
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