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Stereotactic radiotherapy for early stage non-small cell lung cancer.

Ricardi U, Badellino S, Filippi AR - Radiat Oncol J (2015)

Bottom Line: The clinical evidence accumulated in the past decade supports its use as an alternative to surgery with comparable survival outcomes.Due to its limited toxicity, SBRT is also applicable to elderly patients with very poor baseline pulmonary function or other severe comorbidities.Technical aspects and quality of life related issues are also discussed, with the goal to provide information on the current role and limitations of SBRT in clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy.

ABSTRACT
Stereotactic body radiotherapy (SBRT) represents a consolidated treatment option for patients with medically inoperable early stage non-small cell lung cancer (NSCLC). The clinical evidence accumulated in the past decade supports its use as an alternative to surgery with comparable survival outcomes. Due to its limited toxicity, SBRT is also applicable to elderly patients with very poor baseline pulmonary function or other severe comorbidities. Recent comparative studies in operable patients raised the issue of the possible use of SBRT also for this subgroup, with quite promising results that still should be fully confirmed by prospective trials with long-term follow-up. Aim of this review is to summarize and discuss the major studies conducted over the years on SBRT and to provide data on the efficacy and toxicity of this radiotherapy technique for stage I NSCLC. Technical aspects and quality of life related issues are also discussed, with the goal to provide information on the current role and limitations of SBRT in clinical practice.

No MeSH data available.


Related in: MedlinePlus

Typical dose distribution of volumetric modulated arc therapy plan for a peripheral tumor of the right upper lobe (fractionation: 54 Gy in 3 fractions, isodose 80%). PTV, planning target volume; ITV, internal target volume.
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Figure 1: Typical dose distribution of volumetric modulated arc therapy plan for a peripheral tumor of the right upper lobe (fractionation: 54 Gy in 3 fractions, isodose 80%). PTV, planning target volume; ITV, internal target volume.

Mentions: Four-dimensional CT is the recommended technique for SBRT simulation, due to its ability to accurately compensate for target motion and to define patient's specific internal margins. For planning, all published prospective trials have used three-dimensional conformal treatment planning, but more recently, also intensity-modulated radiation therapy (IMRT) and advanced rotational techniques, such as volumetric modulated arc therapy (VMAT), have been widely adopted. VMAT is a form of IMRT in which the gantry continuously moves around the patient with a varying speed and rate of dose delivery. The maximal dose rate reachable by some linear accelerators, with a flattening filter free technique, is up to four times faster than the standard. Fig. 1 illustrated a typical VMAT plan in a man of 78 years old, affected by a peripheral NSCLC in stage IA (cT1aN0M0). When using IMRT planning, larger volumes of normal pulmonary tissue, including contralateral lung, can be exposed to low radiation doses (V5); especially when treating larger tumors, doses to the contralateral lung may predict for the risk of pneumonitis [50]. However, a publication showed no difference in the incidence of radiation pneumonitis between three-dimensional conformal radiation therapy (3D-CRT) and VMAT [47].


Stereotactic radiotherapy for early stage non-small cell lung cancer.

Ricardi U, Badellino S, Filippi AR - Radiat Oncol J (2015)

Typical dose distribution of volumetric modulated arc therapy plan for a peripheral tumor of the right upper lobe (fractionation: 54 Gy in 3 fractions, isodose 80%). PTV, planning target volume; ITV, internal target volume.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493429&req=5

Figure 1: Typical dose distribution of volumetric modulated arc therapy plan for a peripheral tumor of the right upper lobe (fractionation: 54 Gy in 3 fractions, isodose 80%). PTV, planning target volume; ITV, internal target volume.
Mentions: Four-dimensional CT is the recommended technique for SBRT simulation, due to its ability to accurately compensate for target motion and to define patient's specific internal margins. For planning, all published prospective trials have used three-dimensional conformal treatment planning, but more recently, also intensity-modulated radiation therapy (IMRT) and advanced rotational techniques, such as volumetric modulated arc therapy (VMAT), have been widely adopted. VMAT is a form of IMRT in which the gantry continuously moves around the patient with a varying speed and rate of dose delivery. The maximal dose rate reachable by some linear accelerators, with a flattening filter free technique, is up to four times faster than the standard. Fig. 1 illustrated a typical VMAT plan in a man of 78 years old, affected by a peripheral NSCLC in stage IA (cT1aN0M0). When using IMRT planning, larger volumes of normal pulmonary tissue, including contralateral lung, can be exposed to low radiation doses (V5); especially when treating larger tumors, doses to the contralateral lung may predict for the risk of pneumonitis [50]. However, a publication showed no difference in the incidence of radiation pneumonitis between three-dimensional conformal radiation therapy (3D-CRT) and VMAT [47].

Bottom Line: The clinical evidence accumulated in the past decade supports its use as an alternative to surgery with comparable survival outcomes.Due to its limited toxicity, SBRT is also applicable to elderly patients with very poor baseline pulmonary function or other severe comorbidities.Technical aspects and quality of life related issues are also discussed, with the goal to provide information on the current role and limitations of SBRT in clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy.

ABSTRACT
Stereotactic body radiotherapy (SBRT) represents a consolidated treatment option for patients with medically inoperable early stage non-small cell lung cancer (NSCLC). The clinical evidence accumulated in the past decade supports its use as an alternative to surgery with comparable survival outcomes. Due to its limited toxicity, SBRT is also applicable to elderly patients with very poor baseline pulmonary function or other severe comorbidities. Recent comparative studies in operable patients raised the issue of the possible use of SBRT also for this subgroup, with quite promising results that still should be fully confirmed by prospective trials with long-term follow-up. Aim of this review is to summarize and discuss the major studies conducted over the years on SBRT and to provide data on the efficacy and toxicity of this radiotherapy technique for stage I NSCLC. Technical aspects and quality of life related issues are also discussed, with the goal to provide information on the current role and limitations of SBRT in clinical practice.

No MeSH data available.


Related in: MedlinePlus