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Preliminary results of tomotherapy for treatment of inoperable recurrent non-small cell lung cancer at bronchial stump site after right pneumonectomy.

Jang HS, Moon SK - Contemp Oncol (Pozn) (2015)

Bottom Line: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy.The 2-year OS was 39.1%.The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Medical College, Catholic University, St. Mary's Hospital, Seoul, South Korea.

ABSTRACT

Aim of the study: This study aimed to prospectively investigate the clinical outcomes of curative radical helical tomotherapy (HT) applied to recurrent non-small cell lung cancer (NSCLC) at the bronchial stump site after right pneumonectomy. After right pneumonectomy, the heart shifted right laterally. The chambers of the heart closed with a recurrent mass at the bronchial stump were the right atrium and left atrium due to right shifting of the heart. The unfavorable bronchial stump recurrent cancer-heart geometry due to a right shift of the heart might serve as a reliable predictor of cardiac morbidity for aggressive radiotherapy.

Material and methods: The 23 patients received HT for the recurrent NSCLC at the bronchial stump site after right pneumonectomy between 2008 and 2011. The median age of the patients was 65 years (range 56-74).

Results: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy. The median conformal index in the 23 plans was 1.21. The mean fraction of primary PTV receiving more than 95% of the prescribed dose was 97.8%. The mean V45, V50, V60 of the heart were 10.5%, 6.5%, 0.2%, respectively. The median follow-up after tomotherapy was 19.86 months. Median survival was 20 months. The 2-year OS was 39.1%.

Conclusions: The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

No MeSH data available.


Related in: MedlinePlus

Example of isodose distribution and drawing of PTV in a single case. Coronal view (upper photo) and axial view (lower photo). This is the most severe case of tomotherapy performed in recurrent cancer at the right bronchial stump in our hospital. Among 23 subjects of this study, the patient had the biggest GTV volume (322.3cc) and primary PTV volume (761.9cc)
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Figure 0002: Example of isodose distribution and drawing of PTV in a single case. Coronal view (upper photo) and axial view (lower photo). This is the most severe case of tomotherapy performed in recurrent cancer at the right bronchial stump in our hospital. Among 23 subjects of this study, the patient had the biggest GTV volume (322.3cc) and primary PTV volume (761.9cc)

Mentions: The tomotherapy plan for one of the study patients is presented in Fig. 2. This is the most severe case of tomotherapy performed in recurrent cancer at the bronchial stump in our hospital. Among the 23 subjects of this study, the patient had the largest GTV volume (322.3 cc) and primary PTV volume (761.9 cc). This case was diagnosed as NSCLCa (adenocarcinoma) stage IIIA (T2N2M0), surgically proven in October 30, 2002. Main surgery was right pneumonectomy and mediastinal lymph node dissection. The patient underwent 6 sessions of chemotherapy of gemcitabine plus cisplatin postoperatively (from December 5, 2002 to April 11, 2003) and was followed up at 6-month intervals. PET CT and chest CT findings on March 9, 2006 revealed the recurrence at the right bronchial stump site. The patient complained of hoarseness caused by vocal cord paralysis. The second chemotherapy was performed on the patient by changing the chemotherapeutic regimen to paclitaxel plus carboplatin (from March 17, 2006 to January 4, 2007). PET CT findings (May 8, 2008) revealed aggravation of the recurrent mass at the stump site and multiple newly developed metastases in upper paratracheal lymph nodes and both (right and left) supraclavicular lymph nodes. Subsequently, the hematooncologist prescribed erlotinib but suspended the medication due to poor compliance with erlotinib. Instead, we implemented radiotherapy. Relapse sites were characterized by both unfavorable tumor geometry and proximity of the tumor to the heart, esophagus, spinal cord, and the single remaining left lung in radiation therapy. Especially, the radiation exposure to both ventricles of the heart had to be reduced. Since the stump recurrent mass maintained a very close distance with the esophagus in addition to the heart, the likelihood of esophageal toxicity was forecasted to be great. Against this clinical background, tomotherapy of intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) was performed.


Preliminary results of tomotherapy for treatment of inoperable recurrent non-small cell lung cancer at bronchial stump site after right pneumonectomy.

Jang HS, Moon SK - Contemp Oncol (Pozn) (2015)

Example of isodose distribution and drawing of PTV in a single case. Coronal view (upper photo) and axial view (lower photo). This is the most severe case of tomotherapy performed in recurrent cancer at the right bronchial stump in our hospital. Among 23 subjects of this study, the patient had the biggest GTV volume (322.3cc) and primary PTV volume (761.9cc)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507888&req=5

Figure 0002: Example of isodose distribution and drawing of PTV in a single case. Coronal view (upper photo) and axial view (lower photo). This is the most severe case of tomotherapy performed in recurrent cancer at the right bronchial stump in our hospital. Among 23 subjects of this study, the patient had the biggest GTV volume (322.3cc) and primary PTV volume (761.9cc)
Mentions: The tomotherapy plan for one of the study patients is presented in Fig. 2. This is the most severe case of tomotherapy performed in recurrent cancer at the bronchial stump in our hospital. Among the 23 subjects of this study, the patient had the largest GTV volume (322.3 cc) and primary PTV volume (761.9 cc). This case was diagnosed as NSCLCa (adenocarcinoma) stage IIIA (T2N2M0), surgically proven in October 30, 2002. Main surgery was right pneumonectomy and mediastinal lymph node dissection. The patient underwent 6 sessions of chemotherapy of gemcitabine plus cisplatin postoperatively (from December 5, 2002 to April 11, 2003) and was followed up at 6-month intervals. PET CT and chest CT findings on March 9, 2006 revealed the recurrence at the right bronchial stump site. The patient complained of hoarseness caused by vocal cord paralysis. The second chemotherapy was performed on the patient by changing the chemotherapeutic regimen to paclitaxel plus carboplatin (from March 17, 2006 to January 4, 2007). PET CT findings (May 8, 2008) revealed aggravation of the recurrent mass at the stump site and multiple newly developed metastases in upper paratracheal lymph nodes and both (right and left) supraclavicular lymph nodes. Subsequently, the hematooncologist prescribed erlotinib but suspended the medication due to poor compliance with erlotinib. Instead, we implemented radiotherapy. Relapse sites were characterized by both unfavorable tumor geometry and proximity of the tumor to the heart, esophagus, spinal cord, and the single remaining left lung in radiation therapy. Especially, the radiation exposure to both ventricles of the heart had to be reduced. Since the stump recurrent mass maintained a very close distance with the esophagus in addition to the heart, the likelihood of esophageal toxicity was forecasted to be great. Against this clinical background, tomotherapy of intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) was performed.

Bottom Line: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy.The 2-year OS was 39.1%.The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Medical College, Catholic University, St. Mary's Hospital, Seoul, South Korea.

ABSTRACT

Aim of the study: This study aimed to prospectively investigate the clinical outcomes of curative radical helical tomotherapy (HT) applied to recurrent non-small cell lung cancer (NSCLC) at the bronchial stump site after right pneumonectomy. After right pneumonectomy, the heart shifted right laterally. The chambers of the heart closed with a recurrent mass at the bronchial stump were the right atrium and left atrium due to right shifting of the heart. The unfavorable bronchial stump recurrent cancer-heart geometry due to a right shift of the heart might serve as a reliable predictor of cardiac morbidity for aggressive radiotherapy.

Material and methods: The 23 patients received HT for the recurrent NSCLC at the bronchial stump site after right pneumonectomy between 2008 and 2011. The median age of the patients was 65 years (range 56-74).

Results: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy. The median conformal index in the 23 plans was 1.21. The mean fraction of primary PTV receiving more than 95% of the prescribed dose was 97.8%. The mean V45, V50, V60 of the heart were 10.5%, 6.5%, 0.2%, respectively. The median follow-up after tomotherapy was 19.86 months. Median survival was 20 months. The 2-year OS was 39.1%.

Conclusions: The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

No MeSH data available.


Related in: MedlinePlus