Stereotaxic Radiotherapy of Patients with Lung Cancer Stage I–IIa

Purpose: Nowadays the stereotactic radiotherapy (SRT) of patients with clinical stage I–II lung cancer is the choice of the treatment modality for functionally inoperable patients. It shows safety and high efficiency in reaching the local control. Though there is a range of unsolved issues connected with the prediction of treatment efficiency and frequency of complications, an integration of new technologies in the planning and treatment process allows to widen the search of the predictive factors.

Material and methods: Since 2014, 38 patients (T₁N₀M₀ – 16 patients, T₂N₀M₀ – 22 patients) with clinical stage I–IIa lung cancer have underwent SRT. The majority of patients (34) have been recognized as functionally inoperable due to the concurrent broncho-pulmonary pathology, 4 conditionally operable patients have refused an operation. 11 patients had the primary multiple tumors in their anamneses. 35 patients had a peripheral tumor. Used dose fractionation options were: 10 Gy × 5 fractions (n = 25) and 7 Gy × 8 fractions (n = 13) – BED = 100 Gy.

Results: The median follow-up was 26 months (range 3–38 months). The 2-year local control was 94 %. The isolated local recurrences were not registered. Overall and a 2-year recurrence-free survival rate was 84 % (95 % CI: 70–99) and 83.2 % (95 % CI: 70.5–99) respectively. During the first year 4 patients (10 %) had the locoregional and distant progression and 3 of them died. 7 patients had experienced ≥ grade 2 pulmonary toxicity. One patient with the central tumor died from the pulmonary hemorrhage (5-degree toxicity).

Grade 3 chest pain was observed in 2 patients, one of them had a rib fracture. During one-factor analysis a reliable influence on the prognosis of the fractionation regimen (р = 0,04) and, close to reliability, the initial SUV_max  level influence (р = 0,07) were revealed. A reliable relationship between the radiation toxicity level and dosimetric radiation index (V_{10 Gy}, V_{5 Gy}, MLD) was not registered. There was a tendency to the reliable correlation with the total lung capacity indices (р = 0,058).

Conclusions: With modern approaches to SRT treatment planning and delivery there should be a search for additional treatment efficiency and toxicity predictors. The total dose delivery regimen and initial tumor SUV_max can be predictive efficiency factors, while the pulmonary tissue volume can be a predictive toxicity factor.

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