Helical Tomotherapy for Simultaneous Multitarget Radiotherapy for Pulmonary Metastasis
Received 29 July 2008; received in revised form 13 November 2008; accepted 14 November 2008. published online 05 May 2009.
Purpose
To retrospectively evaluate our experience with tomotherapy for simultaneous multitarget radiotherapy in patients with pulmonary metastases.
Methods and Materials
Thirty-one patients were treated with tomotherapy for pulmonary metastases. We defined gross tumor volume (GTV) in computed tomography scans, and the margin of the planning target volume was 1 to 1.5 cm from the GTV. The median doses prescribed were 50 Gy and 40 Gy delivered in 10 fractions over 2 weeks to the 95% isodose volume of the GTV and planning target volume, respectively. Prior to each treatment, online corrections were made in the three axes, and rotation was done after registration of the megavoltage and simulation computed tomography scans. Survival was calculated from the completion of tomotherapy, using the Kaplan-Meier method and log rank test.
Results
The overall survival rate at 12 months was 60.5%, and the median survival time was 16.0 months. A rating of 1 or below on the Eastern Cooperative Oncology Group scale, a breast or colon cancer as the primary cancer, primary lesions that were completely controlled, and a response maintained at 3 months after tomotherapy were shown by univariate analysis to be statistically significant favorable prognostic factors. Progression-free survival rates at 1 and 2 years were 39.6% and 27.7%, respectively. The posttreatment failure rate was 64.5%, the local failure rate was 9.7%, the regional failure rate was 51.6%, and the synchronous local and regional failure rate was 3.2%. Grades I and II radiation-related toxicity levels were observed in 41.9% and 16.0% of patients, respectively. There were no treatment-related deaths.
Conclusions
Tomotherapy could be offered to patients as a safe and effective treatment in select patients with lung metastases. However, large-scale, prospective clinical trials should be done to confirm our results.
∗Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
†Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
‡Department of Diagnostic Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
Reprint requests to: Chul-Seung Kay, M.D., Department of Radiation Oncology, Incheon St. Mary's Hospital, no. 665 Bupyeong6-dong Bupyeon-gu Incheon-si, South Korea. Tel: (82) 32-510-5078; Fax: (82) 32-510-5080
ABSTRACT