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Clinical
Stereotactic body radiotherapy for stage I non-small cell lung cancer
Ben J. Slotman, M.D., Ph.D.
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
Correspondence to: Ben J. Slotman, M.D., Ph.D., Department of Radiation Oncology, VU University Medical Center,
De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Phone: +31-20-4440414; fax: +31-20-4440410; E-mail: [email protected]
(Recevied: September 10, 2010; accepted: October 11, 2010)
In this manuscript, developments in the techniques,
clinical outcome, toxicity, and future perspectives
of SBRT for medically inoperable and operable early
stage NCSLC are discussed. SBRT is well tolerated
and has limited and acceptable side effects. It has
evolved as a standard of care for medically inoperable
patients. These excellent results taken together with
the morbidity and mortality associated with surgery,
might also lead to changes in the treatment for
operable patients.
Keywords: Lung cancer, NSCLC, SBRT, review
Introduction
Lung cancer is the most important cause of cancerrelated death worldwide, with more than one million
deaths every year [1]. Only a minority of patients
presents with Stage I disease, meaning that there is no
evidence of lymph node or distant metastases and no
invasion of structures surrounding the lungs. National
audits in the Netherlands, England and Scandinavia
reveal incidences ranging from 15% to 18% [2,3]. Ageing of the population in the western world will result in
an increase in the number of patients with lung cancer.
These elderly patients generally have multiple co-morbidities precluding or complicating surgery. Screening
of high-risk populations might lead to a further increase
of patients who are detected with Stage I non-small cell
lung cancer (NSCLC).
In accordance with the current the ACCP (American
College of Chest Physicians) clinical practice guide-
lines [4], surgery is still the treatment of choice for
patients with stage I NSCLC. Surgery, ranging from
pneumonectomy to more limited resections using less
invasive techniques, such as video-assisted thoracoscopic surgery (VATS), leads to local control rates of
approximately 90% at 5 years [5]. However surgery is
associated with significant morbidity and has a negative
influence on quality of life, especially after extensive
resections and/or in elderly patients [6]. Smokers are
at increased risk of developing multiple lung tumors,
either synchronous or metachronous [8]. When the
treatment of the first tumor results in significant morbidity and compromised quality of life of the patient,
curative treatment options for a second tumor may be
limited or impossible.
Many patients are considered medically inoperable
because of advanced age and multiple co-morbidities
[9]. Until recently, conventional radiotherapy was the
only alternative treatment option for these patients and
for patients who refused surgery. However, even after
doses of 70 Gy conventional radiotherapy, local control
rates are disappointing [10].
In the last decade, the concept of stereotactic radiotherapy with accurate and reproducible repositioning of
the target volume in three dimensions and the delivery
of very high doses of radiation, delivered in a small
number of fractions, has been extended from the brain
to other sites of the body. Various studies have demonstrated the feasibility of SBRT for stage I NSCLC with
excellent local control rates [11-17].
In this manuscript, developments in the techniques
used, the clinical outcome and toxicity, as well as future
perspectives of SBRT for medically inoperable and
operable early stage NCSLC are described.
Journal of Radiosurgery and SBRT Vol. 1 2011 63
Ben J. Slotman
Techniques
In the early years of SBRT, standard populationbased margins were added to tumors contoured on
a single planning CT scan. More recent studies have
mostly used an internal target volume (ITV) generated
using multiple CT scans, slow CT scans or 4-dimensional CT scans, to obtain information of individualized
tumor mobility [18]. In some centers, the midventilation
position is used for treatment planning [19]. In general,
no separate GTV to CTV margins are used as potential
microscopic disease within the penumbra will receive
sufficient radiation dose [20]. The additional CTV to
PTV margins are dependent on patient setup technique
and possible motion during treatment. Use of online kV
cone-beam CT scans, allows for improved treatment
setup and target verification using soft-tissue matching
on the tumor itself, rather than the bony anatomy of the
patient [21].
For the delivery, in general multiple static beams are
used, eventually in combination with arcs. Liu et al.
[22] suggested that the optimal beam number of beams
for SBRT of lung lesions larger or smaller than 2 cm,
is 9 and 13, respectively. The use of a high number of
non-coplanar fields may improve dose conformity and
reduce doses to the chest wall.
The total delivery time for SBRT comprises of the
time for patient setup and for dose delivery. Reported
median delivery times may be more than 20 minutes
[23] of even 100 minutes [24], depending on doses and
delivery techniques used. Since the risk of tumor and/
or patient movement is likely to increase with longer
delivery times [25], shorter delivery will both ensure
accurate targeting as well as improve patient tolerance
of SBRT procedures. We have demonstrated that volumetric modulated arc therapy using RapidArc enables
fast treatment delivery (currently less than six minutes
for the highest dose) and that the MLC motion does not
interfere with tumor motion [26,27] .
Attempts to reduce motion include the use of respiratory gating, active breath holding or tracking of the
tumor with the radiation beams. Respiratory gating is
performed using internal fiducials, external surrogate
markers, or spirometry. One of the problems of gating
is prolongation of the treatment delivery time. Since
especially for the smaller peripheral tumors, toxicity
without gating is already very low, it has been suggested that its use can be restricted to a selective group
of patients [28]. During treatment, especially in the
treatment of lesions located close to critical structures
or when treatment times are relatively long, verification
of the position during treatment is mandatory. Given the
excellent results of SBRT and the frail patient population in whom the introduction of fiducials may carry
64 Journal of Radiosurgery and SBRT Vol. 1 2011
significant risks, the use of internal markers is generally
not necessary. These medical risks, especially the risk
of pneumothorax, may also prohibit the establishment
of a pathological diagnosis [14]. In selected Western
European populations, investigations revealed that a
combination of positive clinical, radiological and PET
findings may be sufficient, since the risk of non-malignant disease in these patients is below 5 % [29-31].
Various fractionation schemes have been used. Onishi et al. [12] reported that the biologically effective
dose should be above 100 Gy10. We have used three
fractionation schemes and deliver 60 Gy in 3, 5, or 8
fraction, depending on the risk of toxicity [14]. Patients
with T1 tumors which have no broad contact to the
thoracic wall receive 3 fractions (180 Gy10), patients
with T2 tumor or T1 tumors with extensive contact to
the thoracic wall receive 5 fractions (132 Gy10), and
patients with tumors close to critical structures receive
8 fractions (105 Gy10). When comparing dose prescriptions in various studies, not only the prescription isodose (80%, 90%, 95%) should be considered, but also
the algorithm used for correction of tissue inhomogeneity [32]. This is due to the lack of an electronic
equilibrium of the small lesions in the air-filled lung
tissue. Monte Carlo-based treatment planning software
or convolution superposition algorithms have shown to
be most reliable. A number of guidelines for have been
published for the performance of SBRT and the reader
is referred to these papers for further details [19,33].
Tumor control and survival
An increasing number of prospective phase I/II trials, as well as large single- and multicenter studies
have reported on outcomes of SBRT for early stage
NSCLC. Although there is considerable variation in
techniques, total doses, fractionation schemes and type
of equipment used, the local control rates are invariably
reported to be in excess of 85% [11-17]. There are no
randomized studies available comparing conventionally fractionated radiotherapy and SBRT for early stage
NSCLC. However, in many countries SBRT has already
become the new standard of care. This is supported by
a recent meta-analysis showing superior 5-year overall
survival for SBRT compared to conformal radiotherapy
(42% and 20%, respectively) [34].
The assessment of local tumor status after SBRT
can be challenging, since only about 20% of patients
will obtain a radiological complete response [35].
Any suspicion of local tumor progression should be
followed up carefully. Since a substantial percentage
of patients may show increased 18FDG uptake in the
tumor during the first year without subsequent evi-
Stereotactic radiotherapy for lung cancer
dence of local failure, FDG-PET scanning may be
unreliable after SBRT [36].
Although no treatment of the regional lymph nodes
is given with SBRT, hilar or mediastinal lymph node
recurrences are seen in only 5 – 10% of patients [14-17],
which is similar to results after surgery [37]. Since after
a negative FDG-PET scan, pathological nodal involvement is found in up to one third of patients [37,38], the
local SBRT seems to have an impact on the subclinical regional disease. Although it has been speculated
that the lower dose contribution from treatment of the
primary tumor might play a role [39], the possibility
of an immunological effect which is provoked by the
ablative therapy of the primary tumor [40], seems more
appealing.
On the basis of studies with sufficiently long follow-up, Chi et al. in a review estimated the risk of distant metastases in the range of 10-30% [41]. Because
the risk of distant failure is significantly higher in T2
tumors [14,16,41], the initiation of studies on the role of
(neo-)adjuvant chemotherapy in these patients has been
advocated. In their review, Chi et al. [41] reported overall survival at 2 years around 65% and at 5 years around
45-50%. Disease-specific survival was around 80% and
55%, at 2 and 5 years, respectively [41].
three-fraction SBRT scheme received less than 3×7.0
Gy the risk was 0%, and it increased to 5% and 50%
after doses of 3×9.1 Gy and 3×16.6 Gy, respectively
[46].
Treatment of tumors in the apex may lead to radiation-induced plexopathy. In a series of 37 apical lesions,
the two-year risk of brachial plexopathy was 46% for
BED greater than 100 Gy3 versus 8% for a BED ≤ 100
Gy3 [47]. The authors conclude that the maximum dose
to the plexus should be kept below 26 Gy in 3 or 4 fractions. Timmerman et al. [48] reported a high incidence
of toxicity in patients with central tumors receiving
very high doses (60-66 Gy in 3 fractions). However,
when the fractionation scheme is adjusted for the risk of
complications and the 60 Gy is delivered in 8 instead of
3 fractions [14], no increased toxicity is observed [42].
SBRT does not adversely influence the pulmonary
function [49,50]. Therefore, patients should not be
excluded from SBRT on the basis of poor lung function tests. We reported that even patients with a secondary primary tumor after previous pneumonectomy
can undergo curative SBRT [51]. An analysis of a large
group of elderly (≥75 years) patients with significant
co-morbidities also showed the safety of SBRT in these
vulnerable patients [52]. In addition, SBRT has been
shown to have no adverse effect on quality of life [53].
Toxicity
Future perspectives
The SBRT treatment is generally well tolerated with
minimal acute side effects. Severe toxicity after SBRT
for early stage NSCLC is reported to be less than 5%
after adequate patient selection and use of risk-adapted
fractionation schemes [14,42]. However, these toxicity data may be an underestimation because of the still
limited long-term follow-up and the relatively high
mortality from other disease in medically inoperable
NSCLC patients. Additionally, pulmonary toxicity may
be masked by exacerbations of COPD and pneumonias.
The most frequently reported toxicities are radiation
pneumonitis and rib fractures [14,42]. The incidence of
grade 3 or higher pneumonitis is reported to be 0–5%,
which is not different from that described after conventional high-dose radiotherapy [12,14,15,35,42]. In
patients with peripheral tumors, late toxicity, including
chest wall pain, fibrosis and rib fractures, is reported in
up to 10% of patients [14,16,42-44]. Dunlap et al. [45]
suggested that to reduce toxicity, the chest wall volume
receiving more than 30 Gy in three to five fractions,
should be limited to less than 30cm3. Pettersson et al.
[46] found that for prediction of chest wall toxicity,
absolute volumes provided better fits than relative volumes and dose-response curves were more suitable than
volume-response curves. When 2 cm3 of the ribs for a
We recently performed an analysis of the treatment
utilization and survival, using population-based cancer registry data [54]. This study in a region of about
3 million people, clearly showed that the introduction
of SBRT for stage I patients, resulted in a significant
increase in the use of radiotherapy in elderly patients.
In addition, since the introduction of SBRT, there was
a significant increase in survival for the patients treated
with radiotherapy [54]. For elderly patients, use of a
single fraction scheme may be even more convenient
and lead to a increased use of SBRT in frail elderly
patients who otherwise would remain untreated. Within
the RTOG, a randomized phase II study has been initiated to compare a single fraction of 34 Gy with a dose
of 48 Gy in four fractions (study 0915; NTC00960999).
The primary endpoint of this study is Grade 3 or higher
toxicity after 1 year.
The excellent results of SBRT in medically inoperable patient have led to the idea that SBRT might
have a role in operable patients as well. Surgery has
traditionally been the treatment of choice for early
stage NSCLC. Because of the inferior survival rate of
conventional radiotherapy, this has become a dogma
and the associated morbidity, mortality and drop in
Journal of Radiosurgery and SBRT Vol. 1 2011 65
Ben J. Slotman
quality of life [7,55] are generally accepted. However,
even after surgery, 5 year survival is only around 75%
for pathological Stage IA disease and for pathological Stage IB, it ranges from 35 to 58%, depending on
the size of the tumor [56]. A number of large surgical
series have revealed local failures rates varying from
5 to 13% and combined loco-regional failure rates 8
and 16% [5,57-59]. In view of the developments in the
field of SBRT, a reassessment of the role of surgery is
mandatory.
Grills et al. [36], compared the outcome of patients
receiving either wedge resection or SBRT in their
center. Patients who underwent SBRT were older
and had more severe co-morbidity. There was a nonsignificant difference in local control rate in favor of
SBRT (4% versus 20%). There were no statistically
significant differences in regional recurrence and distant metastases rates. As can be expected based on the
differences in age and medical condition between the
two groups, overall survival was better in the surgical
group, but disease specific survival was identical. The
surgery group showed a much higher rate of treatmentrelated morbidity in the surgery group [36]. The study
has been criticized because of its retrospective nature,
differences in patients characteristics between the two
groups, use of wedge resection for larger and more centrally located tumors and the shorter follow up in the
SBRT-group [60].
In a review of the literature, Nguyen et al. compared outcome after VATS lobectomy and SBRT and
concluded that local control and survival were comparable [39]. However SBRT was associated with
fewer complications and morbidity and the authors
suggest that SBRT might become the standard of care
for operable Stage I patients as well [39]. Onishi et al.
reported excellent outcome in a series of 87 patients
with operable stage I NSCLC, treated with SBRT [61].
The 5 year local control rates were 92% for T1 and
73% for T2 tumors. Currently, a prospective phase II
trial of the Japanese Clinical Oncology Group (0403;
NCT00238875) is underway, with overall survival at 3
years as the primary endpoint [62]. Within the RTOG,
SBRT is also being evaluated in operable Stage I/II
patients (study 0618; NCT00551369). In this study, the
primary endpoint is local control at 2 years. Two randomized trials comparing SBRT and surgery are currently accruing patients. In the Netherlands, the ROSEL
trial has been initiated for patients with Stage IA disease (NCT00687986). Primary endpoints are tumor
control at 2 years, quality of life and treatment costs.
In the international STARS trial, Cyberknife SBRT is
compared with surgery (NCT00840749), with overall
survival at 3 years as the primary endpoint. These studies will also help answering the question on untreated
occult nodal disease and whether salvage surgery is
66 Journal of Radiosurgery and SBRT Vol. 1 2011
feasible after SBRT. Both randomized trials will need
about 1000 patients and it will take several years before
the results will become available.
Conclusions
In the last decade, technical improvements have enabled the introduction of SBRT for a variety of tumor
sites on a large scale. In early stage NSCLC, SBRT has
evolved as a standard of care for medically inoperable
patients. SBRT is well tolerated and has limited and
acceptable side effects. These excellent results taken
together with the morbidity and mortality associated
with surgery, might alter the treatment for operable
patients as well.
References
1.
Parkin DM. Global cancer statistics in the year 2000. Lancet
Oncol 2001, 2, 533-543.
2.
de Jong WK, Schaapveld M, Blaauwgeers JL, Groen HJ.
Pulmonary tumours in the Netherlands: focus on temporal
trends in histology and stage and on rare tumours.Thorax 2008,
63, 196-1102.
3.
Holmberg L, Sandin F, Bray F, Richards M, Spicer J, Lambe M,
Klint A, Peake M, Strand TE, Linklater K, Robinson D, Møller
H. National comparisons of lung cancer survival in England,
Norway and Sweden 2001-2004: differences occur early in
follow-up. Thorax 2010, 65, 436-441.
4.
Scott WJ, Howington J, Feigenberg S, Movsas B, Pisters K;
American College of Chest Physicians.Treatment of non-small
cell lung cancer stage I and stage II: ACCP evidence-based
clinical practice guidelines (2nd edition). Chest 2007, 132,
234S-242S.
5.
Kelsey CR, Marks LB, Hollis D, Hubbs JL, Ready NE, D’Amico
TA, Boyd JA. Local recurrence after surgery for early stage lung
cancer: an 11-year experience with 975 patients. Cancer 2009,
115, 5218-5227.
6.
Kenny PM, King MT, Viney RC, Boyer MJ, Pollicino CA,
McLean JM, Fulham MJ, McCaughan BC. Quality of life and
survival in the 2 years after surgery for non small-cell lung
cancer. J Clin Oncol 2008, 26, 233-241.
7.
Schulte T, Schniewind B, Walter J, Dohrmann P, Küchler T,
Kurdow R. Age-related impairment of quality of life after lung
resection for non-small cell lung cancer. Lung Cancer 2010, 68,
115-120.
8.
Gazdar AF, Minna JD. Multifocal lung cancers--clonality vs
field cancerization and does it matter? J Natl Cancer Inst 2009,
101, 541-543.
9.
Coebergh JW, Janssen-Heijnen ML, Post PN, Razenberg PP.
Serious co-morbidity among unselected cancer patients newly
diagnosed in the southeastern part of The Netherlands in 19931996. J Clin Epidemiol 1999, 52, 1131-1136.
Stereotactic radiotherapy for lung cancer
10. Qiao X, Tullgren O, Lax I, Sirzén F, Lewensohn R. The role of
radiotherapy in treatment of stage I non-small cell lung cancer.
Lung Cancer. 2003, 41, 1-11.
accuracy using three-dimensional cone-beam computed
tomography for stereotactic body radiotherapy. Int J Radiat
Oncol Biol Phys 2009, 73, 571-577.
11. Timmerman R, Papiez L, McGarry R, Likes L, DesRosiers C,
Frost S, Williams M. Extracranial stereotactic radioablation:
results of a phase I study in medically inoperable stage I nonsmall cell lung cancer. Chest 2003, 124, 1946-1955.
22. Liu R, Buatti JM, Howes TL, Dill J, Modrick JM, Meeks SL.
Optimal number of beams for stereotactic body radiotherapy of
lung and liver lesions. Int J Radiat Oncol Biol Phys 2006, 66,
906-912.
12. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi
K, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T,
Takeda A, Ouchi A, Hareyama M, Kokubo M, Hara R, Itami J,
Yamada K, Araki T. Hypofractionated stereotactic radiotherapy
(HypoFXSRT) for stage I non-small cell lung cancer: updated
results of 257 patients in a Japanese multi-institutional study. J
Thorac Oncol 2007, 2, S94-100.
23. Hodge W, Tomé WA, Jaradat HA, Orton NP, Khuntia D, Traynor
A, Weigel T, Mehta MP. Feasibility report of image guided
stereotactic body radiotherapy (IG-SBRT) with tomotherapy
for early stage medically inoperable lung cancer using extreme
hypofractionation. Acta Oncol 2006, 45, 890-896.
13. Fakiris AJ, McGarry RC, Yiannoutsos CT, Papiez L, Williams
M, Henderson MA, Timmerman R. Stereotactic body radiation
therapy for early-stage non-small-cell lung carcinoma: fouryear results of a prospective phase II study. Int J Radiat Oncol
Biol Phys 2009, 75, 677-682.
14. Lagerwaard FJ, Haasbeek CJ, Smit EF, Slotman BJ, Senan S.
Outcomes of risk-adapted fractionated stereotactic radiotherapy
for stage I non-small-cell lung cancer.Int J Radiat Oncol Biol
Phys 2008, 70, 685-692.
15. Inoue T, Shimizu S, Onimaru R, Takeda A, Onishi H, Nagata Y,
Kimura T, Karasawa K, Arimoto T, Hareyama M, Kikuchi E,
Shirato H. Clinical outcomes of stereotactic body radiotherapy
for small lung lesions clinically diagnosed as primary lung
cancer on radiologic examination. Int J Radiat Oncol Biol Phys
2009, 75, 683-687.
16. Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G,
Lax I, Drugge N, Ekberg L, Friesland S, Johansson KA, Lund
JA, Morhed E, Nilsson K, Levin N, Paludan M, Sederholm C,
Traberg A, Wittgren L, Lewensohn R. Outcome in a prospective
phase II trial of medically inoperable stage I non-small-cell lung
cancer patients treated with stereotactic body radiotherapy. J
Clin Oncol 2009, 27, 3290-3296.
17. Stephans KL, Djemil T, Reddy CA, Gajdos SM, Kolar M,
Mason D, Murthy S, Rice TW, Mazzone P, Machuzak M,
Mekhail T, Videtic GM. A comparison of two stereotactic body
radiation fractionation schedules for medically inoperable stage
I non-small cell lung cancer: the Cleveland Clinic experience. J
Thorac Oncol 2009, 4, 976-982.
18. Slotman BJ, Lagerwaard FJ, Senan S. 4D imaging for target
definition in stereotactic radiotherapy for lung cancer. Acta
Oncol 2006, 45, 966-972.
19. Hurkmans CW, Cuijpers JP, Lagerwaard FJ, Widder J, van
der Heide UA, Schuring D, Senan S. Recommendations for
implementing stereotactic radiotherapy in peripheral stage IA
non-small cell lung cancer: report from the Quality Assurance
Working Party of the randomised phase III ROSEL study.
Radiat Oncol 2009, 4, 1.
20. Timmerman R, Galvin J, Michalski J, Straube W, Ibbott
G, Martin E, Abdulrahman R, Swann S, Fowler J, Choy H.
Accreditation and quality assurance for Radiation Therapy
Oncology Group: Multicenter clinical trials using Stereotactic
Body Radiation Therapy in lung cancer. Acta Oncol 2006, 45,
779-786.
21. Wang Z, Nelson JW, Yoo S, Wu QJ, Kirkpatrick JP, Marks LB,
Yin FF. Refinement of treatment setup and target localization
24. van der Voort van Zyp NC, Prévost JB, Hoogeman MS, Praag
J, van der Holt B, Levendag PC, van Klaveren RJ, Pattynama
P, Nuyttens JJ. Stereotactic radiotherapy with real-time tumor
tracking for non-small cell lung cancer: clinical outcome.
Radiother Oncol 2009, 91, 296-300.
25. Purdie TG, Bissonnette JP, Franks K, Bezjak A, Payne D, Sie
F, Sharpe MB, Jaffray DA. Cone-beam computed tomography
for on-line image guidance of lung stereotactic radiotherapy:
localization, verification, and intrafraction tumor position. Int J
Radiat Oncol Biol Phys 2007, 68, 243-252.
26. Verbakel WF, Senan S, Cuijpers JP, Slotman BJ, Lagerwaard FJ.
Rapid delivery of stereotactic radiotherapy for peripheral lung
tumors using volumetric intensity-modulated arcs. Radiother
Oncol 2009, 1, 122-4.
27. Ong C, Verbakel WF, Cuijpers JP, Slotman BJ, Senan S.
Dosimetric impact of interplay effect on RapidArc lung
stereotactic treatment delivery. Int J Radiat Oncol Biol Phys
2010 Jul 12 (EPub ahead of print).
28. Underberg RW, Lagerwaard FJ, Slotman BJ, Cuijpers JP, Senan
S. Benefit of respiration-gated stereotactic radiotherapy for
stage I lung cancer: an analysis of 4DCT datasets. Int J Radiat
Oncol Biol Phys 2005, 62, 554-560.
29. van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH,
Schreurs AJ, Stallaert RA, van Velthoven PC, Comans EF,
Diepenhorst FW, Verboom P, van Mourik JC, Postmus PE, Boers
M, Teule GJ. Effectiveness of positron emission tomography in
the preoperative assessment of patients with suspected nonsmall-cell lung cancer: the PLUS multicentre randomised trial.
Lancet. 2002, 359, 1388-1393.
30. Herder GJ, Kramer H, Hoekstra OS, Smit EF, Pruim J, van
Tinteren H, Comans EF, Verboom P, Uyl-de Groot CA,
Welling A, Paul MA, Boers M, Postmus PE, Teule GJ, Groen
HJ; POORT Study Group. Traditional versus up-front [18F]
fluorodeoxyglucose-positron emission tomography staging of
non-small-cell lung cancer: a Dutch cooperative randomized
study. J Clin Oncol 2006 24, 1800-1806.
31. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen
A, Ravn J, Clementsen P, Høgholm A, Larsen K, Rasmussen T,
Keiding S, Dirksen A, Gerke O, Skov B, Steffensen I, Hansen
H, Vilmann P, Jacobsen G, Backer V, Maltbaek N, Pedersen
J, Madsen H, Nielsen H, Højgaard L. Preoperative staging of
lung cancer with combined PET-CT. N Engl J Med 2009, 361,
32-39.
32. Schuring D, Hurkmans CW. Developing and evaluating
stereotactic lung RT trials: what we should know about the
influence of inhomogeneity corrections on dose. Radiat Oncol
2008, 3, 21.
Journal of Radiosurgery and SBRT Vol. 1 2011 67
Ben J. Slotman
33. Potters L, Kavanagh B, Galvin JM, Hevezi JM, Janjan NA,
Larson DA, Mehta MP, Ryu S, Steinberg M, Timmerman R,
Welsh JS, Rosenthal SA; American Society for Therapeutic
Radiology and Oncology; American College of Radiology.
American Society for Therapeutic Radiology and Oncology
(ASTRO) and American College of Radiology (ACR) practice
guideline for the performance of stereotactic body radiation
therapy. Int J Radiat Oncol Biol Phys 2010, 76, 326-332.
34. Grutters JP, Kessels AG, Pijls-Johannesma M, De Ruysscher
D, Joore MA, Lambin P. Comparison of the effectiveness of
radiotherapy with photons, protons and carbon-ions for nonsmall cell lung cancer: a meta-analysis. Radiother Oncol 2010,
95, 32-40.
35. Takeda A, Kunieda E, Takeda T, Tanaka M, Sanuki N, Fujii
H, Shigematsu N, Kubo A. Possible misinterpretation of
demarcated solid patterns of radiation fibrosis on CT scans
as tumor recurrence in patients receiving hypofractionated
stereotactic radiotherapy for lung cancer. Int J Radiat Oncol
Biol Phys 2008, 70, 1057-1065.
36. Henderson MA, Hoopes DJ, Fletcher JW, Lin PF, Tann M,
Yiannoutsos CT, Williams MD, Fakiris AJ, McGarry RC,
Timmerman RD. A pilot trial of serial 18F-fluorodeoxyglucose
positron emission tomography in patients with medically
inoperable stage I non-small-cell lung cancer treated with
hypofractionated stereotactic body radiotherapy. Int J Radiat
Oncol Biol Phys 2010, 76, 789-795.
37. Cerfolio RJ, Bryant AS. Survival of patients with true pathologic
stage I non-small cell lung cancer. Ann Thorac Surg 2009, 88,
917-922
38. Reed CE, Harpole DH, Posther KE, Woolson SL, Downey RJ,
Meyers BF, Heelan RT, MacApinlac HA, Jung SH, Silvestri
GA, Siegel BA, Rusch VW; American College of Surgeons
Oncology Group Z0050 trial. Results of the American College
of Surgeons Oncology Group Z0050 trial: the utility of positron
emission tomography in staging potentially operable non-small
cell lung cancer. J Thorac Cardiovasc Surg 2003, 126, 19431951.
39. Grills IS, Mangona VS, Welsh R, Chmielewski G, McInerney E,
Martin S, Wloch J, Ye H, Kestin LL. Outcomes after stereotactic
lung radiotherapy or wedge resection for stage I non-small-cell
lung cancer. J Clin Oncol 2010, 28, 928-935.
44. Voroney JP, Hope A, Dahele MR, Purdie TG, Franks KN,
Pearson S, Cho JB, Sun A, Payne DG, Bissonnette JP, Bezjak
A, Brade AM. Chest wall pain and rib fracture after stereotactic
radiotherapy for peripheral non-small cell lung cancer. J Thorac
Oncol 2009, 4, 1035-1037.
45. Dunlap NE, Cai J, Biedermann GB, Yang W, Benedict SH,
Sheng K, Schefter TE, Kavanagh BD, Larner JM. Chest wall
volume receiving >30 Gy predicts risk of severe pain and/or rib
fracture after lung stereotactic body radiotherapy. Int J Radiat
Oncol Biol Phys 2010,76, 796-801.
46. Pettersson N, Nyman J, Johansson KA. Radiation-induced rib
fractures after hypofractionated stereotactic body radiation
therapy of non-small cell lung cancer: a dose- and volumeresponse analysis. Radiother Oncol 2009, 91, 360-368.
47. Forquer JA, Fakiris AJ, Timmerman RD, Lo SS, Perkins
SM, McGarry RC, Johnstone PA. Brachial plexopathy from
stereotactic body radiotherapy in early-stage NSCLC: doselimiting toxicity in apical tumor sites. Radiother Oncol 2009,
93, 408-413.
48. Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K,
DeLuca J, Ewing M, Abdulrahman R, DesRosiers C, Williams
M, Fletcher J. Excessive toxicity when treating central tumors
in a phase II study of stereotactic body radiation therapy for
medically inoperable early-stage lung cancer. J Clin Oncol
2006, 24, 4833-4839.
49. Henderson M, McGarry R, Yiannoutsos C, Fakiris A, Hoopes
D, Williams M, Timmerman R. Baseline pulmonary function as
a predictor for survival and decline in pulmonary function over
time in patients undergoing stereotactic body radiotherapy for
the treatment of stage I non-small-cell lung cancer. Int J Radiat
Oncol Biol Phys 2008, 72, 404-409.
50. Stephans KL, Djemil T, Reddy CA, Gajdos SM, Kolar M,
Machuzak M, Mazzone P, Videtic GM. Comprehensive
analysis of pulmonary function Test (PFT) changes after
stereotactic body radiotherapy (SBRT) for stage I lung
cancer in medically inoperable patients. J Thorac Oncol
2009, 4, 838-844.
51. Haasbeek CJ, Lagerwaard FJ, de Jaeger K, Slotman BJ, Senan
S. Outcomes of stereotactic radiotherapy for a new clinical
stage I lung cancer arising postpneumonectomy. Cancer 2009,
115, 587-594.
40. Lee Y, Auh SL, Wang Y, Burnette B, Wang Y, Meng Y, Beckett
M, Sharma R, Chin R, Tu T, Weichselbaum RR, Fu YX.
Therapeutic effects of ablative radiation on local tumor require
CD8+ T cells: changing strategies for cancer treatment. Blood
2009, 114, 589-595.
52. Haasbeek CJ, Lagerwaard FJ, Antonisse ME, Slotman BJ,
Senan S. Stage I nonsmall cell lung cancer in patients aged >
or =75 years: outcomes after stereotactic radiotherapy. Cancer
2010, 116, 406-414.
41. Chi A, Liao Z, Nguyen NP, Xu J, Stea B, Komaki R. Systemic
review of the patterns of failure following stereotactic body
radiation therapy in early-stage non-small-cell lung cancer:
clinical implications. Radiother Oncol 2010, 1, 1-11.
53. Senan S, Gundy VC, Haasbeek CJ, Slotman BJ, Aaronson NK,
Lagerwaard FJ. Health-related quality of life (HRQOL) after
stereotactic body radiotherapy (SBRT) for stage I non-small cell
lung cancer (NSCLC). J Clin Oncol 2010, 28, 15s (abstr 7079).
42. Nguyen NP, Garland L, Welsh J, Hamilton R, Cohen D,
Vinh-Hung V. Can stereotactic fractionated radiation therapy
become the standard of care for early stage non-small cell lung
carcinoma. Cancer Treat Rev 2008, 34, 719-727.
54. Palma DA, Visser O, Lagerwaard FJ, Belderbos J, Slotman
BJ, Senan S., The impact of introducing stereotactic lung
radiotherapy for elderly patients with Stage I NSCLC± A
population/based time/trend analysis. J Clin Oncol 2010
(accepted for publication).
43. Kawase T, Takeda A, Kunieda E, Kokubo M, Kamikubo Y,
Ishibashi R, Nagaoka T, Shigematsu N, Kubo A. Extrapulmonary
soft-tissue fibrosis resulting from hypofractionated stereotactic
body radiotherapy for pulmonary nodular lesions. Int J Radiat
Oncol Biol Phys 2009, 74, 349-354.
55. Balduyck B, Hendriks J, Lauwers P, Sardari Nia P, Van
Schil P. Quality of life evolution after lung cancer surgery in
septuagenarians: a prospective study. Eur J Cardiothorac Surg
2009, 35, 1070-1075
68 Journal of Radiosurgery and SBRT Vol. 1 2011
Stereotactic radiotherapy for lung cancer
56. Rami-Porta R, Ball D, Crowley J, Giroux DJ, Jett J, Travis
WD, Tsuboi M, Vallières E, Goldstraw P; International Staging
Committee; Cancer Research and Biostatistics; Observers to the
Committee; Participating Institutions. The IASLC Lung Cancer
Staging Project: proposals for the revision of the T descriptors
in the forthcoming (seventh) edition of the TNM classification
for lung cancer. J Thorac Oncol 2007, 2, 593-602.
57. Martini N, Bains MS, Burt ME, Zakowski MF, McCormack
P, Rusch VW, Ginsberg RJ. Incidence of local recurrence and
second primary tumors in resected stage I lung cancer. J Thorac
Cardiovasc Surg 1995, 109, 120-129.
58. El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF,
Fernando HC, Urda SJ, Luketich JD, Landreneau RJ. Outcomes
of sublobar resection versus lobectomy for stage I non-small
cell lung cancer: a 13-year analysis. Ann Thorac Surg 2006, 82,
408-416.
risk in resected stage I non-small cell lung cancer. Am J Clin
Oncol 2008, 31, 22-28.
60. Altorki NK. Stereotactic body radiation therapy versus wedge
resection for medically inoperable stage I lung cancer: tailored
therapy or one size fits all? J Clin Oncol 2010, 28, 905-907.
61. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K,
Karasawa K, Hayakawa K, Niibe Y, Takai Y, Kimura T, Takeda
A, Ouchi A, Hareyama M, Kokubo M, Kozuka T, Arimoto
T, Hara R, Itami J, Araki T. Stereotactic Body Radiotherapy
(SBRT) for operable stage I non-small-cell lung cancer: Can
SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys
2010 Jul 15 (EPub ahead of print)
62. Hiraoka M, Ishikura S. A Japan clinical oncology group trial
for stereotactic body radiation therapy of non-small cell lung
cancer. J Thorac Oncol 2007, 2 (Suppl 3), S115-S117.
59. Goodgame B, Viswanathan A, Miller CR, Gao F, Meyers B,
Battafarano RJ, Patterson A, Cooper J, Guthrie TJ, Bradley J,
Pillot G, Govindan R. A clinical model to estimate recurrence
Journal of Radiosurgery and SBRT Vol. 1 2011 69