Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial

• Published in: The Annals of thoracic surgery Vol. 75; no. 4; pp. 1097 - 1101
• Main Authors: Whyte, Richard I, Crownover, Richard, Murphy, Martin J, Martin, David P, Rice, Thomas W, DeCamp, Malcolm M, Rodebaugh, Raymond, Weinhous, Martin S, Le, Quynh-Thu
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2003; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Feasibility Studies; Female; Follow-Up Studies; Humans; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Radiosurgery - adverse effects; Radiosurgery - methods; Safety; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; 10; Human; Lung disease; Prognosis; Respiratory disease; Treatment efficiency; Mortality; Instrumentation therapy; Intraoperative; Malignant tumor; Radiotherapy; Bronchopulmonary; Morbidity; Treatment; Surgery; Stereotaxic surgery; Phase I trial; Bronchus disease; Combined treatment; Technique
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(02)04681-7

Stereotactic radiosurgery is well established for the treatment of intracranial neoplasms but its use for lung tumors is novel. Twenty-three patients with biopsy-proven lung tumors were recruited into a two-institution, dose-escalation, phase I clinical trial using a frameless stereotactic radiosurgery system (CyberKnife). Fifteen patients had primary lung tumors and 8 had metastatic tumors. The age range was 23 to 87 years (mean, 63 years). After undergoing computed tomography–guided percutaneous placement of two to four small metal fiducials directly into the tumor, patients received 1,500 cGY of radiation in a single fraction using a linear accelerator mounted on a computer-controlled robotic arm. Safety, feasibility, and efficacy were studied. Nine patients were treated with a breath-holding technique, and 14 with a respiratory-gating, automated, robotic technique. Tumor size ranged from 1 to 5 cm in maximal diameter. There were four complications related to fiducial placement: three pneumothoraces requiring chest tube insertion and one emphysema exacerbation. There were no grade 3 to 5 radiation-related complications. Follow-up ranged from 1 to 26 months (mean, 7.0 months). Radiographic response was scored as complete in 2 patients, partial in 15, stable in 4, and progressive in 2. Four patients died of non–treatment-related causes at 1, 5, 9, and 11 months after radiation. Single-fraction stereotactic radiosurgery is safe and feasible for the treatment of selected lung tumors. Additional studies are planned to investigate the optimal radiation dose, best motion-suppression technique, and overall treatment efficacy.