Clinical outcomes of stereotactic radiotherapy for stage I non-small cell lung cancer using a novel irradiation technique: patient self-controlled breath-hold and beam switching using a combination of linear accelerator and CT scanner.

We have developed a novel irradiation technique for lung cancer that combines a linear accelerator and CT scanner with patient-controlled breath-hold and radiation beam switching. We applied this technique to stereotactic three-dimensional (3D) conformal radiotherapy for stage I non-small cell lung cancer (NSCLC) and evaluated the primary therapeutic outcomes. A total of 35 patients with stage I (15 IA, 20 IB) primary NSCLC (20 adeno, 13 squamous cell, and 2 others) were treated with this technique. Patients ranged from 65 to 92 years old (median, 78 years). Twenty-three (66%) patients were medically inoperable due to mainly chronic pulmonary disease or high age. Three-dimensional treatment plans were made using 10 different non-coplanar dynamic arcs. The total dose of 60 Gy was delivered in 10 fractions (over 5-8 days) at the minimum dose point in the planning target volume (PTV) using a 6 MV X-ray. After adjusting the isocenter of the PTV to the planned position by a unit comprising CT and linear accelerator, irradiation was performed under patient-controlled breath-hold and radiation beam switching. All patients completed the treatment course without complaint. Complete response (CR) and partial response (PR) rates were 8/35 (23%) and 25/35 (71%), respectively. Pulmonary complications of National Cancer Institute-Common Toxicity Criteria grade >2 were noted in three (9%) patients. During follow-up (range, 6-30 months; median, 13 months), two (6%) patients developed local progression and five (14%) developed distant or regional lymph node metastases. Two-year overall survival rates for total patients and medically operable patients were 58 and 83%, respectively. In conclusion, this new irradiation technique, utilizing patient-controlled radiation beam switching under self-breath-hold after precise alignment of the isocenter, allows safe high-dose stereotactic radiotherapy with sufficient margins around the CTV and reduced treatment times. Based on the initial results, excellent local control with minimal complications is expected for stage I NSCLC.

Onishi H ，Kuriyama K ，Komiyama T ，Tanaka S ，Sano N ，Marino K ，Ikenaga S ，Araki T ，Uematsu M ... -  《LUNG CANCER》

Hypofractionated high-dose proton beam therapy for stage I non-small-cell lung cancer: preliminary results of a phase I/II clinical study.

Hata M ，Tokuuye K ，Kagei K ，Sugahara S ，Nakayama H ，Fukumitsu N ，Hashimoto T ，Mizumoto M ，Ohara K ，Akine Y ... -  《INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS》

Stereotactic, high single-dose irradiation of stage I non-small cell lung cancer (NSCLC) using four-dimensional CT scans for treatment planning.

Fritz P ，Kraus HJ ，Blaschke T ，Mühlnickel W ，Strauch K ，Engel-Riedel W ，Chemaissani A ，Stoelben E ... -  《LUNG CANCER》

Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer.

Xia T ，Li H ，Sun Q ，Wang Y ，Fan N ，Yu Y ，Li P ，Chang JY ... -  《INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS》

Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries.

Baumann P ，Nyman J ，Lax I ，Friesland S ，Hoyer M ，Rehn Ericsson S ，Johansson KA ，Ekberg L ，Morhed E ，Paludan M ，Wittgren L ，Blomgren H ，Lewensohn R ... -  《ACTA ONCOLOGICA》