Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Body Radiotherapy for Pulmonary Nodular Lesions
To clarify the incidence, symptoms, and timing of extrapulmonary fibrosis developing after hypofractionated stereotactic body radiotherapy.
We analyzed 379 consecutive patients who underwent stereotactic body radiotherapy for lung tumors at four institutions between February 2001 and March 2007. The median follow-up time was 29 months (range, 1-72). We investigated the subjective and objective characteristics of the extrapulmonary masses, redelineated the origin tissue of each on the treatment planning computed tomography scan, and generated dose-volume histograms.
In 9 patients (2.4%), extrapulmonary masses were found 3-36 months (median, 14) after irradiation. Coexisting swelling occurred in 3 patients, chest pain in 2, thumb numbness in 1, and arm edema in 1 patient. Extrapulmonary masses occurred in 5 (5.4%) of 92 and 4 (1.4%) of 287 patients irradiated with a 62.5-Gy and 48.0-Gy isocenter dose, respectively. The mean and maximal dose to the origin tissue was 25.8-53.9 Gy (median, 43.7) and 47.5-62.5 Gy (median, 50.2), respectively. In 5 of 9 patients, the standardized uptake values on 18F-fluorodeoxyglucose-positron emission tomography was 1.8-2.8 (median, 2.2). Percutaneous needle biopsy was performed in 3 patients, and all the specimens showed benign fibrotic changes without malignant cells.
All patients should be carefully followed after stereotactic body radiotherapy. The findings of any new lesion should prompt an assessment for radiation-induced extrapulmonary fibrosis before an immediate diagnosis of recurrence is made. Careful beam-shape modification and dose prescription near the thoracic outlet are required to prevent forearm neuropathy and lymphedema.
Available from: Janjira Petsuksiri
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ABSTRACT: 68 L ReviewArticle ung cancer is the most common cancer world-wide and accounts for the most cancer-related deaths. 1 The most common lung cancer is non-small cell lung cancer (NSCLC), which accounts for 80% of all lung cancer cases. Approximately 15-20% of the diagnosed NSCLC patients present with early-stage (stage I) disease. 2 The International Early Lung Cancer Action Program Investigators 3 reported the results of their large, collaborative, 12-year lung cancer screening study using spiral CT. Of 31,567 symptomatic participants at high risk of lung cancer, 484 were found to have lung cancer, which was of clinical stage I in 85% of cases. The standard therapy for stage I NSCLC is surgical resection, consisting of either lobectomy or pneumonectomy, as well as nodal dissection, with a 5-year overall survival ranging from 50% to 70%. 4 An anatomic lobectomy is recommended in patients who are able to tolerate the procedure, because the locoregional recurrence rate was three times greater in the limited resection group (17%) than in the lobectomy group (6%). 5 The average 5-year survival rate for patients with stage I NSCLC is approximately 65% (range 55-90%). 6 Moreover, the estimated 10-year survival rate was 88% for stage I lung cancer patients who were diagnosed by CT screening and 92% for the patients who underwent surgi-cal resection within 1 month after diagnosis. 3 In contrast, McGarry et al., reported that lung cancer was shown to be the cause of death in 53% of 49 stage I medically inoperable patients not receiving definitive therapy. 7 However, there are patients with stage I NSCLC who cannot undergo surgery because of their poor lung function, cardiac function, bleeding tendency, or other co-morbidities. The alternative treatment options for these ABSTRACT Stereotactic Body Radiotherapy (SBRT) is one kind of emerging advanced radiotherapy that uses a high dose of radiation delivered to a precise target. The results of treatment by SBRT in inoperable stage I non-small cell lung cancer (NSCLC) are very impressive from both retrospective and prospective studies. The local control is up to 85% and the result suggests improved overall survival with little toxicity compared to the conventional fractionation technique. With its excellent result and safety record, SBRT should be considered as an optional treatment for inoperable stage I NSCLC.
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ABSTRACT: In early stage non-small cell lung cancer (NSCLC), recent data from both prospective clinical trials and single institutions indicate that local control rates in excess of 88% can be achieved using stereotactic radiotherapy (SRT). Treatment-related toxicity is uncommon when "risk-adapted" fractionation schemes are applied, with lower dose per fraction used for larger tumors and when the planning target volume is in the proximity of critical structures. Both the superior outcome and convenience of fewer visits have led to a preference for SRT over conventional radiotherapy in countries such as Japan and the Netherlands. Reports on outcomes of SRT in patients unfit to undergo surgery may underestimate late toxicity as such patients have significant non-cancer related mortality. The evolution of technology has allowed for further improvements in the accuracy and speed of SRT delivery. Recent advances such as on-board imaging and intensity-modulated arc delivery techniques have improved treatment accuracy and tolerability, as well as the confidence of clinicians in applying SRT outside the setting of specialized tertiary institutions. Studies comparing primary surgery with SRT are underway, but the available data are compelling enough to allow SRT to be considered an established treatment option in patients who are aged 75 years and older, and in whom the estimated risks of postoperative mortality rates are high. The clinical development of SRT will be greatly facilitated by improvements in diagnostic procedures for peripheral pulmonary nodules. However, treatment without pathological confirmation may be justified in medically inoperable patients if the risk of malignancy is sufficiently high as to warrant an invasive diagnostic procedure.
Available from: PubMed Central
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ABSTRACT: Stage I lung cancer has a high cure rate with surgery, although many patients are not surgical candidates due to comorbid conditions. Historically, non-operative treatment has been disappointing. New and promising ablative therapies offer a curative option.
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