Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Outcome of Helical Tomotherapy for Inoperable Non-Small Cell Lung Cancer: The Kyung Hee University Medical Center Experience

  • Kong, Moonkyoo (Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Hong, Seong Eon (Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine)
  • Published : 2014.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Published studies on clinical outcome of helical tomotherapy for lung cancer are limited. The purpose of this study was to evaluate clinical outcomes and treatment-related toxicity in inoperable non-small cell lung cancer (NSCLC) patients treated with helical tomotherapy in Korea. Materials and Methods: Twenty-seven patients with NSCLC were included in this retrospective study. Radiotherapy was performed using helical tomotherapy with a daily dose of 2.1-3 Gy delivered at 5 fractions per week resulting in a total dose of 62.5-69.3 Gy. We assessed radiation-related lung and esophageal toxicity, and analyzed overall survival, locoregional recurrence-free survival, distant metastasis-free survival, and prognostic factors for overall survival. Results: The median follow-up period was 28.9 months (range, 10.1-69.4). The median overall survival time was 28.9 months, and 1-, 2-, and 3-year overall survival rates were 96.2%, 92.0%, and 60.0%. The median locoregional recurrence-free survival time was 24.3 months, and 1-, 2-, and 3-year locoregional recurrence-free survival rates were 85.2%, 64.5%, and 50.3%. The median distant metastasis-free survival time was 26.7 months, and 1-, 2-, and 3-year distant metastasis-free survival rates were 92.3%, 83.9%, and 65.3%, respectively. Gross tumor volume was the most significant prognostic factor for overall survival. No grade 4 or more toxicity was observed. Conclusions: Helical tomotherapy in patients with inoperable NSCLC resulted in high survival rates with an acceptable level of toxicity, suggesting it is an effective treatment option in patients with medically inoperable NSCLC.

Keywords

References

  1. Bradley J, Graham MV, Winter K, et al (2005). Toxicity and outcome results of RTOG 9311: a phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys, 61, 318-28. https://doi.org/10.1016/j.ijrobp.2004.06.260
  2. Brenner DJ, Doll R, Goodhead DT, et al (2003). Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA, 100, 13761-6. https://doi.org/10.1073/pnas.2235592100
  3. Cattaneo GM, Dell'oca I, Broggi S, et al (2008). Treatment planning comparison between conformal radiotherapy and helical tomotherapy in the case of locally advanced-stage NSCLC. Radiother Oncol, 88, 310-8. https://doi.org/10.1016/j.radonc.2008.06.006
  4. Chang JY, Liu HH, Komaki R (2005). Intensity modulated radiation therapy and proton radiotherapy for non-small cell lung cancer. Curr Oncol Rep, 7, 255-9. https://doi.org/10.1007/s11912-005-0047-4
  5. Christian JA, Bedford JL, Webb S, Brada M (2007). Comparison of inverse-planned three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 67, 735-41. https://doi.org/10.1016/j.ijrobp.2006.09.047
  6. Ding XP, Zhang J, Li BS, et al (2012). Feasibility of shrinking field radiation therapy through 18F-FDG PET/CT after 40 Gy for stage III non-small cell lung cancers. Asian Pac J Cancer Prev, 13, 319-23. https://doi.org/10.7314/APJCP.2012.13.1.319
  7. Gopal R, Tucker SL, Komaki R, et al (2003). The relationship between local dose and loss of function for irradiated lung. Int J Radiat Oncol Biol Phys, 56, 106-13. https://doi.org/10.1016/S0360-3016(03)00094-4
  8. Govaert SL, Troost EG, Schuurbiers OC, et al (2012). Treatment outcome and toxicity of intensity-modulated (chemo) radiotherapy in stage III non-small cell lung cancer patients. Radiat Oncol, 7, 150. https://doi.org/10.1186/1748-717X-7-150
  9. Grills IS, Yan D, Martinez AA, et al (2003). Potential for reduced toxicity and dose escalation in the treatment of inoperable non-small-cell lung cancer: a comparison of intensity-modulated radiation therapy (IMRT), 3D conformal radiation, and elective nodal irradiation. Int J Radiat Oncol Biol Phys, 57, 875-90. https://doi.org/10.1016/S0360-3016(03)00743-0
  10. Hall EJ (2006). Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys, 65, 1-7. https://doi.org/10.1016/j.ijrobp.2006.01.027
  11. Jiang ZQ, Yang K, Komaki R, et al (2012). Long-term clinical outcome of intensity-modulated radiotherapy for inoperable non-small cell lung cancer: the MD Anderson experience. Int J Radiat Oncol Biol Phys, 83, 332-9. https://doi.org/10.1016/j.ijrobp.2011.06.1963
  12. Kron T, Grigorov G, Yu E, et al (2004). Planning evaluation of radiotherapy for complex lung cancer cases using helical tomotherapy. Phys Med Biol, 49, 3675-90. https://doi.org/10.1088/0031-9155/49/16/014
  13. Lee JH, Wu HG, Kim HJ, et al (2013). Hypofractionated three-dimensional conformal radiotherapy for medically inoperable early stage non-small-cell lung cancer. Radiat Oncol J, 31, 18-24. https://doi.org/10.3857/roj.2013.31.1.18
  14. Liao ZX, Komaki RR, Thames HD Jr, et al (2010). Influence of technologic advances on outcomes in patients with unresectable, locally advanced non-small-cell lung cancer receiving concomitant chemoradiotherapy. Int J Radiat Oncol Biol Phys, 76, 775-81. https://doi.org/10.1016/j.ijrobp.2009.02.032
  15. Liu HH, Wang X, Dong L, et al (2004). Feasibility of sparing lung and other thoracic structures with intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 58, 1268-79. https://doi.org/10.1016/j.ijrobp.2003.09.085
  16. Liu YC, Zhou SB, Gao F, et al (2013). Chemotherapy and late course three dimensional conformal radiotherapy for treatment of patients with stage III non- small cell lung cancer. Asian Pac J Cancer Prev, 14, 2663-5. https://doi.org/10.7314/APJCP.2013.14.4.2663
  17. Mackie TR, Holmes T, Swerdloff S, et al (1993). Tomotherapy: a new concept for the delivery of dynamic conformal radiotherapy. Med Phys, 20, 1709-19. https://doi.org/10.1118/1.596958
  18. Mehta M, Scrimger R, Mackie R, et al (2001). A new approach to dose escalation in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 49, 23-33. https://doi.org/10.1016/S0360-3016(00)01374-2
  19. Murshed H, Liu HH, Liao Z, et al (2004). Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 58, 1258-67. https://doi.org/10.1016/j.ijrobp.2003.09.086
  20. Rengan R, Rosenzweig KE, Venkatraman E, et al (2004). Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 60, 741-7. https://doi.org/10.1016/j.ijrobp.2004.04.013
  21. Rosenzweig KE, Fox JL, Yorke E, et al (2005). Results of a phase I dose-escalation study using three-dimensional conformal radiotherapy in the treatment of inoperable nonsmall cell lung carcinoma. Cancer, 103, 2118-27. https://doi.org/10.1002/cncr.21007
  22. Schwarz M, Alber M, Lebesque JV, Mijnheer BJ, Damen EM (2005). Dose heterogeneity in the target volume and intensity-modulated radiotherapy to escalate the dose in the treatment of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 62, 561-70. https://doi.org/10.1016/j.ijrobp.2005.02.011
  23. Scrimger RA, Tome WA, Olivera GH, et al (2003). Reduction in radiation dose to lung and other normal tissues using helical tomotherapy to treat lung cancer, in comparison to conventional field arrangements. Am J Clin Oncol, 26, 70-8. https://doi.org/10.1097/00000421-200302000-00014
  24. Sura S, Gupta V, Yorke E, et al (2008). Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience. Radiother Oncol, 87, 17-23. https://doi.org/10.1016/j.radonc.2008.02.005
  25. Wu VW, Kwong DL,Sham JS (2004). Target dose conformity in 3-dimensional conformal radiotherapy and intensity modulated radiotherapy. Radiother Oncol, 71, 201-6. https://doi.org/10.1016/j.radonc.2004.03.004
  26. Yom SS, Liao Z, Liu HH, et al (2007). Initial evaluation of treatment-related pneumonitis in advanced-stage nonsmall- cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 68, 94-102. https://doi.org/10.1016/j.ijrobp.2006.12.031
  27. Zheng DJ, Yu GH, Gao JF, Gu JD (2013). Concomitant EGFR inhibitors combined with radiation for treatment of nonsmall cell lung carcinoma. Asian Pac J Cancer Prev, 14, 4485-94. https://doi.org/10.7314/APJCP.2013.14.8.4485

Cited by

  1. Evaluation of the Radiation Pneumonia Development Risk in Lung Cancer Cases vol.15, pp.17, 2014, https://doi.org/10.7314/APJCP.2014.15.17.7371