Stereotactic single-dose radiotherapy of stage I non–small-cell lung cancer (NSCLC)

Hof, Holger; Herfarth, Klaus K; Münter, Marc; Hoess, Angelika; Motsch, Johann; Wannenmacher, Michael; Debus, J.ürgen

doi:10.1016/S0360-3016(02)04504-2

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Volume 56, Issue 2 , Pages 335-341, 1 June 2003

Stereotactic single-dose radiotherapy of stage I non–small-cell lung cancer (NSCLC)

Holger Hof, M.D.
- Department of Radiological Diagnostics and Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany
- Reprint requests to: Dr. Holger Hof, DKFZ (German Cancer Research Center), Dept. E0500, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. Tel: +49 6221 422587; Fax: +49 6221 422514;
Klaus K Herfarth, M.D.
- Department of Radiological Diagnostics and Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany
Marc Münter, M.D.
- Department of Radiological Diagnostics and Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany
Angelika Hoess, M.Sc.
- Department of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Departments of
Johann Motsch, M.D.
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
Michael Wannenmacher, M.D.
- Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany
J.ürgen Debus, M.D., Ph.D.
- Department of Radiological Diagnostics and Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany

Received 10 June 2002; received in revised form 6 November 2002

Abstract

Purpose

The treatment of early-stage lung cancers is a primary domain of thoracic surgery, leading to persuasive results. In patients with medical contraindications, radiotherapy is an alternative, although with considerably worse outcome. Radiotherapy is associated with the risk of severe acute side effects and a permanent decrease of lung function. By the introduction of an extracranial stereotactic treatment technique, the amount of normal tissue in the high-dose region can be reduced, allowing the performance of single-dose treatment with high, biologically effective doses.

Methods and materials

Between October 1998 and May 2001, 10 patients with histologically confirmed Stage I non–small-cell lung cancer were treated with stereotactic single-dose radiotherapy. A self-developed stereotactic frame was used for patient positioning and navigation. Total doses applied ranged from 19 to 26 Gy. After treatment, regular CT-based follow-up was performed.

Results

During a median follow-up period of 14.9 months, the tumors in 8 of 10 patients were locally controlled. The actuarial overall survival was 80% and 64%, respectively, 12 and 24 months after therapy. Actuarial local recurrence–free survival reached 88.9% and 71.1%, respectively. Therapy-related perifocal normal-tissue reaction occurred in 70% of all treated patients, although no major clinical symptoms were seen. In 5 patients, systemic metastases were found during follow-up; 1 patient developed suspect mediastinal lymph nodes.

Conclusion

Stereotactic single-fraction radiotherapy is a feasible, safe, and effective procedure for the treatment of Stage I non–small-cell lung cancer. It promises high local control with a reduced overall treatment time. However, further investigation in a larger patient collective with extended follow-up is necessary.

Keywords: Lung cancer, Stereotactic radiotherapy, Single-dose treatment