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CyberKnife Frameless Image-Guided High-Dose Fractionated Stereotactic Radiosurgery with the Synchrony Motion Tracking Module in the Treatment of Single Small Peripheral Lung Tumors

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Treating Tumors that Move with Respiration

16.1 Abstract

Curative surgery is not an option for many patients with clinical stage I non-small-cell lung carcinoma (NSCLC) because of associated comorbidities. Stereotactic radiosurgery with the CyberKnife® (Accuray Incorporated, Sunnyvale, CA) tumor tracking system may be an option for many of these medically inoperable patients. Here we provide a concise overview of the standard treatment options for stage I lung cancer and a practical summary of the Georgetown University Hospital stereotactic radiosurgery treatment protocol. We review preliminary outcomes for single small peripheral lung tumors uniformly treated with the CyberKnife using the Synchrony® (Accuray Incorporated, Sunnyvale, CA) motion tracking module.

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References

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106–130.

    Article  PubMed  Google Scholar 

  2. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99–105.

    Article  PubMed  CAS  Google Scholar 

  3. Oken mm, Marcus PM, Hu P, et al. Baseline chest radiograph for lung cancer detection in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. J Natl Cancer Inst 2005;97:1832–1839.

    Article  PubMed  Google Scholar 

  4. Gohagan JK, Marcus PM, Fagerstrom RM, et al. Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. Lung Cancer 2005;47:9–15.

    Article  PubMed  Google Scholar 

  5. Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763–1771.

    Article  PubMed  Google Scholar 

  6. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 2006;81:1013–1019; discussion 1019–1020.

    Article  PubMed  Google Scholar 

  7. Handy JR, Jr., Asaph JW, Skokan L, et al. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest 2002;122:21–30.

    Article  PubMed  Google Scholar 

  8. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 1995;60:615–622; discussion 622–613.

    Article  PubMed  CAS  Google Scholar 

  9. Birdas TJ, Koehler RP, Colonias A, et al. Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer. Ann Thorac Surg 2006;81:434–438; discussion 438–439.

    Article  PubMed  Google Scholar 

  10. d’Amato TA, Galloway M, Szydlowski G, et al. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest 1998;114:1112–1115.

    PubMed  CAS  Google Scholar 

  11. Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2005;129:261–267.

    Article  PubMed  Google Scholar 

  12. Group LCS. Effects of postoperative mediastinal radiation on completely resected stage II and stage III epidermoid cancer of the lung. N Engl J Med 1986;315:1377–1381.

    Article  Google Scholar 

  13. Keller SM, Adak S, Wagner H, et al. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer. Eastern Cooperative Oncology Group. N Engl J Med 2000;343:1217–1222.

    Article  PubMed  CAS  Google Scholar 

  14. Lee W, Daly BD, DiPetrillo TA, et al. Limited resection for non-small cell lung cancer: observed local control with implantation of I-125 brachytherapy seeds. Ann Thorac Surg 2003;75:237–242; discussion 242–233.

    Article  PubMed  Google Scholar 

  15. Santos R, Colonias A, Parda D, et al. Comparison between sublobar resection and 125Iodine brachytherapy after sublobar resection in high-risk patients with Stage I non-small-cell lung cancer. Surgery 2003;134:691–697; discussion 697.

    Article  PubMed  Google Scholar 

  16. Qiao X, Tullgren O, Lax I, et al. The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer 2003;41:1–11.

    Article  PubMed  Google Scholar 

  17. Fletcher GH. Clinical dose-response curves of human malignant epithelial tumours. Br J Radiol 1973;46:1–12.

    Article  PubMed  CAS  Google Scholar 

  18. Sibley GS, Jamieson TA, Marks LB, et al. Radiotherapy alone for medically inoperable stage I non-small-cell lung cancer: the Duke experience. Int J Radiat Oncol Biol Phys 1998;40:149–154.

    Article  PubMed  CAS  Google Scholar 

  19. Saunders M, Dische S, Barrett A, et al. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee. Radiother Oncol 1999;52:137–148.

    Article  PubMed  CAS  Google Scholar 

  20. Withers HR, Taylor JM, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988;27:131–146.

    PubMed  CAS  Google Scholar 

  21. Emami B, Purdy JA, Manolis J, et al. Three-dimensional treatment planning for lung cancer. Int J Radiat Oncol Biol Phys 1991;21:217–227.

    PubMed  CAS  Google Scholar 

  22. Blomgren H, Lax I, Naslund I, et al. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol 1995;34:861–870.

    PubMed  CAS  Google Scholar 

  23. Bradley J, Graham MV, Winter K, et al. Toxicity and outcome results of RTOG 9311: a phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 2005;61:318–328.

    Article  PubMed  Google Scholar 

  24. Kong FM, Ten Haken RK, Schipper MJ, et al. High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable nonsmall-cell lung cancer: long-term results of a radiation dose escalation study. Int J Radiat Oncol Biol Phys 2005;63:324–333.

    Article  PubMed  Google Scholar 

  25. Rosenzweig KE, Fox JL, Yorke E, et al. Results of a phase I dose-escalation study using three-dimensional conformal radiotherapy in the treatment of inoperable nonsmall cell lung carcinoma. Cancer 2005;103:2118–2127.

    Article  PubMed  Google Scholar 

  26. Chen M, Hayman JA, Ten Haken RK, et al. Long-term results of high-dose conformal radiotherapy for patients with medically inoperable T 1-3N0 non-small-cell lung cancer: is low incidence of regional failure due to incidental nodal irradiation? Int J Radiat Oncol Biol Phys 2006;64:120–126.

    Article  PubMed  Google Scholar 

  27. Lax I, Blomgren H, Naslund I, et al. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol 1994;33:677–683.

    PubMed  CAS  Google Scholar 

  28. McGarry RC, Papiez L, Williams M, et al. Stereotactic body radiation therapy of early-stage non-small-cell lung carcinoma: phase I study. Int J Radiat Oncol Biol Phys 2005;63:1010–1015.

    Article  PubMed  Google Scholar 

  29. Timmerman R, Papiez L, McGarry R, et al. Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Chest 2003;124:1946–1955.

    Article  PubMed  Google Scholar 

  30. Fukumoto S, Shirato H, Shimzu S, et al. Small-volume image-guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas. Cancer 2002;95:1546–1553.

    Article  PubMed  Google Scholar 

  31. Nagata Y, Takayama K, Matsuo Y, et al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2005;63:1427–1431.

    Article  PubMed  Google Scholar 

  32. Onishi H, Araki T, Shirato H, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 2004;101:1623–1631.

    Article  PubMed  Google Scholar 

  33. Uematsu M, Shioda A, Suda A, et al. Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. Int J Radiat Oncol Biol Phys 2001;51:666–670.

    Article  PubMed  CAS  Google Scholar 

  34. Wulf J, Haedinger U, Oppitz U, et al. Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: a noninvasive treatment approach in medically inoperable patients. Int J Radiat Oncol Biol Phys 2004;60:186–196.

    Article  PubMed  Google Scholar 

  35. Nyman J, Johansson KA, Hulten U. Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer-mature results for medically inoperable patients. Lung Cancer 2006;51:97–103.

    Article  PubMed  Google Scholar 

  36. Takayama K, Nagata Y, Negoro Y, et al. Treatment planning of stereotactic radiotherapy for solitary lung tumor. Int J Radiat Oncol Biol Phys 2005;61:1565–1571.

    Article  PubMed  Google Scholar 

  37. Degen JW, Gagnon GJ, Voyadzis JM, et al. CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. J Neurosurg Spine 2005;2:540–549.

    PubMed  Google Scholar 

  38. Whyte RI, Crownover R, Murphy MJ, et al. Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial. Ann Thorac Surg 2003;75:1097–1101.

    Article  PubMed  Google Scholar 

  39. Papiez L, Timmerman R, DesRosiers C, et al. Extracranial stereotactic radioablation: physical principles. Acta Oncol 2003;42:882–894.

    Article  PubMed  Google Scholar 

  40. Goldstein NS, Ferkowicz M, Kestin L, et al. Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol 2003;120:720–724.

    Article  PubMed  Google Scholar 

  41. Giraud P, Antoine M, Larrouy A, et al. Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning. Int J Radiat Oncol Biol Phys 2000;48:1015–1024.

    Article  PubMed  CAS  Google Scholar 

  42. Schweikard A, Shiomi H, Adler J. Respiration tracking in radiosurgery. Med Phys 2004;31:2738–2741.

    Article  PubMed  Google Scholar 

  43. Travis WD, Colby TV, Corrin B. World Health Organization Pathology Panel: World Health Organization Histologic Typing of Lung and Pleural Tumors. In: International Histological Classification of Tumors. Vol 3rd. Berlin: Springer-Verlag; 1999.

    Google Scholar 

  44. Fowler JF, Tome WA, Fenwick JD, et al. A challenge to traditional radiation oncology. Int J Radiat Oncol Biol Phys 2004;60:1241–1256.

    Article  PubMed  Google Scholar 

  45. Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999;45:323–329.

    Article  PubMed  CAS  Google Scholar 

  46. Paludan M, Traberg Hansen A, Petersen J, et al. Aggravation of dyspnea in stage I non-small cell lung cancer patients following stereotactic body radiotherapy: Is there a dose-volume dependency? Acta Oncol 2006;45:818–822.

    Article  PubMed  Google Scholar 

  47. Inoue A, Saijo Y, Maemondo M, et al. Severe acute interstitial pneumonia and gefitinib. Lancet 2003;361:137–139.

    Article  PubMed  Google Scholar 

  48. Reichner CA, Collins BT, Gagnon GJ, et al. The placement of gold fiducials for CyberKnife stereotactic radiosurgery using a modified transbronchial needle aspiration technique. Journal of Bronchology 2005;12:193–195.

    Article  Google Scholar 

  49. Schwarz Y, Greif J, Becker HD, et al. Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study. Chest 2006;129:988–994.

    Article  PubMed  Google Scholar 

  50. Schwarz Y, Mehta AC, Ernst A, et al. Electromagnetic navigation during flexible bronchoscopy. Respiration 2003;70:516–522.

    Article  PubMed  Google Scholar 

  51. Schweikard A, Shiomi H, Fisseler J. Fiducial-less Respiration tracking in radiosurgery. Med Robotics & Computer Assisted Surgery 2005;1:19–27.

    Article  CAS  Google Scholar 

  52. Wisnivesky JP, Yankelevitz D, Henschke CI. The effect of tumor size on curability of stage I non-small cell lung cancers. Chest 2004;126:761–765.

    Article  PubMed  Google Scholar 

  53. Ketchedjian A, Daly BD, Fernando HC, et al. Location as an important predictor of lymph node involvement for pulmonary adenocarcinoma. J Thorac Cardiovasc Surg 2006;132:544–548.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA

    Brian T. Collins MD (Assistant Professor), Sean P. Collins MD, PhD (Assistant Professor), Sonja Dieterich PhD (Assistant Professor Director of CyberKnife Physics) & Donald A. McRae PhD (Associate Professor Director of Physics)

  2. Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA

    Kelly Erickson BA (Medical Student)

  3. Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, NW LL Bles Building, Washington, DC, 20007, USA

    Gregory J. Gagnon MD (Associate Professor and CyberKnife Program Director Interim Chairman)

  4. Pulmonary Critical Care & Sleep Medicine, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA

    Cristina Reichner MD, FCCP (Assistant Professor of Medicine) & Eric D. Anderson MD, FCCP (Assistant Professor of Medicine)

  5. Division of Interventional Radiology Department of Radiology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA

    Thomas Chang MD (Assistant Professor of Radiology)

  6. Department of Radiology, 3800 Reservoir Road, NW, Washington, DC, 20007, USA

    Carlos Jamis-Dow MD (Assistant Professor Chief of Cardiothoracic Imaging)

  7. Division of Interventional Radiology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA

    Filip Banovac MD (Clinical Director of Imaging Sciences & Information Systems Center Assistant Professor of Radiology)

  8. Division of Hematology/Oncology, Georgetown University Hospital P Lombardi, 3800 Reservoir Road, NW, Washington, DC, 20007-2197, USA

    Shakun Malik MD (Associate Professor of Medicine)

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  1. Brian T. Collins MD
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  2. Kelly Erickson BA
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  3. Sean P. Collins MD, PhD
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  4. Gregory J. Gagnon MD
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  7. Cristina Reichner MD, FCCP
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Editor information

Editors and Affiliations

  1. Research, Education and Clinical Excellence, Baylor University Medical Center, 1201 Barnett Tower 3600 Gaston Avenue, Dallas, TX, 75246, USA

    Harold C. Urschel Jr. MD (Chair of Cardiovascular and Thoracic Surgical) (Chair of Cardiovascular and Thoracic Surgical)

  2. Arizona Oncology Services at St. Joseph’s Hospital & Medical Center Department of Radiation Oncology CyberKnife Center Barrow Neurological Institute, Gamma Knife Center, 350 West Thomas Road, Phoenix, Arizona, 85013, USA

    John J. Kresl MD, PhD

  3. The Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, PUH, C-800, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    James D. Luketich MD (Sampson Family Endowed Professor of Surgery Chief) (Sampson Family Endowed Professor of Surgery Chief)

  4. Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, TX, 75390, USA

    Lech Papiez PhD (Associate Professor) & Robert D. Timmerman MD (Professor and Vice-Chairman Effie Marie Cain Distinguished Chair in Cancer Therapy Research) (Associate Professor) &  (Professor and Vice-Chairman Effie Marie Cain Distinguished Chair in Cancer Therapy Research)

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Collins, B.T. et al. (2007). CyberKnife Frameless Image-Guided High-Dose Fractionated Stereotactic Radiosurgery with the Synchrony Motion Tracking Module in the Treatment of Single Small Peripheral Lung Tumors. In: Urschel, H.C., Kresl, J.J., Luketich, J.D., Papiez, L., Timmerman, R.D., Schulz, R.A. (eds) Treating Tumors that Move with Respiration. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69886-9_16

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  • DOI: https://doi.org/10.1007/978-3-540-69886-9_16

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69885-2

  • Online ISBN: 978-3-540-69886-9

  • eBook Packages: MedicineMedicine (R0)

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