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Clinical outcome of fiducial-less CyberKnife radiosurgery for stage I non-small cell lung cancer.

Jung IH, Song SY, Jung J, Cho B, Kwak J, Je HU, Choi W, Jung NH, Kim SS, Choi EK - Radiat Oncol J (2015)

Bottom Line: Eight patients died due to cancer progression.The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker.Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS).

Materials and methods: From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21.

Results: The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression.

Conclusion: The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

No MeSH data available.


Related in: MedlinePlus

Xsight lung tracking system. (A) Tracking. Before radiation delivery, Xsight lung tracking system starts to track the tumor. It will take about 5-10 minutes. (B) Beam on. If Xsight lung tracking system localized the tumor, delivery of radiation starts. (C) Beam off. If Xsight lung tracking system missed the tumor, delivery of radiation stops and the system re-tracks the location of tumor.
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Figure 1: Xsight lung tracking system. (A) Tracking. Before radiation delivery, Xsight lung tracking system starts to track the tumor. It will take about 5-10 minutes. (B) Beam on. If Xsight lung tracking system localized the tumor, delivery of radiation starts. (C) Beam off. If Xsight lung tracking system missed the tumor, delivery of radiation stops and the system re-tracks the location of tumor.

Mentions: The Xsight lung tracking system (Accuray Inc.) [10] with the Synchrony Respiratory Tracking System makes it possible for direct lung tumor tracking without fiducial markers using pattern-similarity matching algorithms. As shown in Fig. 1, lung tumor location is determined by matching the orthogonal image pair of the patient from a dual X-ray in-room radiograph system with the digitally reconstructed radiographs pre-calculated from the planning computed tomography (CT) data. A series of the tumor locations obtained over various respiratory phases are then correlated with the external respiratory signal with Synchrony system for real-time tumor tracking. Over the beam delivery period, the tumor localization procedure by acquisition of the orthogonal X-ray images is repeated with the interval of 30 to 60 seconds, and used for the correction of the correlation model that can be eventually changed over time. To improve overall tracking accuracy, a spine-based alignment is performed as a pre-setup stage before the direct tumor positioning. In general, the following conditions are recommended for this system to ensure the direct tumor detectability: a tumor larger than 15 mm in all axes, located at the periphery, and not complete obstructed by spine on live X-ray projection images.


Clinical outcome of fiducial-less CyberKnife radiosurgery for stage I non-small cell lung cancer.

Jung IH, Song SY, Jung J, Cho B, Kwak J, Je HU, Choi W, Jung NH, Kim SS, Choi EK - Radiat Oncol J (2015)

Xsight lung tracking system. (A) Tracking. Before radiation delivery, Xsight lung tracking system starts to track the tumor. It will take about 5-10 minutes. (B) Beam on. If Xsight lung tracking system localized the tumor, delivery of radiation starts. (C) Beam off. If Xsight lung tracking system missed the tumor, delivery of radiation stops and the system re-tracks the location of tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493433&req=5

Figure 1: Xsight lung tracking system. (A) Tracking. Before radiation delivery, Xsight lung tracking system starts to track the tumor. It will take about 5-10 minutes. (B) Beam on. If Xsight lung tracking system localized the tumor, delivery of radiation starts. (C) Beam off. If Xsight lung tracking system missed the tumor, delivery of radiation stops and the system re-tracks the location of tumor.
Mentions: The Xsight lung tracking system (Accuray Inc.) [10] with the Synchrony Respiratory Tracking System makes it possible for direct lung tumor tracking without fiducial markers using pattern-similarity matching algorithms. As shown in Fig. 1, lung tumor location is determined by matching the orthogonal image pair of the patient from a dual X-ray in-room radiograph system with the digitally reconstructed radiographs pre-calculated from the planning computed tomography (CT) data. A series of the tumor locations obtained over various respiratory phases are then correlated with the external respiratory signal with Synchrony system for real-time tumor tracking. Over the beam delivery period, the tumor localization procedure by acquisition of the orthogonal X-ray images is repeated with the interval of 30 to 60 seconds, and used for the correction of the correlation model that can be eventually changed over time. To improve overall tracking accuracy, a spine-based alignment is performed as a pre-setup stage before the direct tumor positioning. In general, the following conditions are recommended for this system to ensure the direct tumor detectability: a tumor larger than 15 mm in all axes, located at the periphery, and not complete obstructed by spine on live X-ray projection images.

Bottom Line: Eight patients died due to cancer progression.The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker.Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS).

Materials and methods: From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21.

Results: The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression.

Conclusion: The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

No MeSH data available.


Related in: MedlinePlus