Stereotactic body radiotherapy in lung cancer: an update

Abreu, Carlos Eduardo Cintra Vita; Ferreira, Paula Pratti Rodrigues; Moraes, Fabio Ynoe de; Neves Jr, Wellington Furtado Pimenta; Gadia, Rafael; Carvalho, Heloisa de Andrade

doi:10.1590/S1806-37132015000000034

Carlos Eduardo Cintra Vita Abreu

Departamento de Radioterapia, Hospital Sírio-Libanês, São Paulo (SP) Brasil.

Paula Pratti Rodrigues Ferreira

Departamento de Radioterapia, Hospital Sírio-Libanês, São Paulo (SP) Brasil.

Fabio Ynoe de Moraes

Departamento de Radioterapia, Hospital Sírio-Libanês, São Paulo (SP) Brasil.

Wellington Furtado Pimenta Neves Jr

Departamento de Radioterapia, Hospital Sírio-Libanês, São Paulo (SP) Brasil.

Rafael Gadia

Departamento de Radioterapia, Hospital Sírio-Libanês, Brasília (DF) Brasil.

Heloisa de Andrade Carvalho

Departamento de Radioterapia, Hospital Sírio-Libanês, São Paulo (SP) Brasil.

Serviço de Radioterapia, Departamento de Radiologia e Oncologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.

Correspondence to: Heloisa de Andrade Carvalho. Rua Dona Adma Jafet, 91, CEP 01308-050, São Paulo, SP, Brasil. Tel.: 55 11 3394-5367. E-mail:heloisa.carvalho@hc.fm.usp.br

Study	Number of patients	Dose	Central or peripheral lesion	Local control	Complications
Onishi et al.²¹21 . Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. 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(7 Suppl 3):S94-100. http://dx.doi.org/10.1097/JTO.0b013e318074de34 http://dx.doi.org/10.1097/JTO.0b013e3180...	257	1-14 fractions (30-84 Gy)	both	84% (5 years) BED ≥ 100 Gy	≥ grade 3: pulmonary complications, in 5.4%; esophageal complications, in 1.0%; dermatitis, in 1.2%
Nagata et al.²²22 . Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Stereotactic Body Radiation Therapy For T1N0M0 Non-small Cell Lung Cancer: First Report for Inoperable Population of a Phase II Trial by Japan Clinical Oncology Group (JCOG 0403). Int J Radiat Oncol Biol Phys. 2012;84(Suppl):S46. http://dx.doi.org/10.1016/j.ijrobp.2012.07.330 http://dx.doi.org/10.1016/j.ijrobp.2012....	104	4 × 12 Gy	both	3-year progression-free survival, 69%	grade 3: dyspnea, in 9%; pneumonitis, in 7%; intercostal pain, in 2%; cough, in 1% grade 4: dyspnea, in 1%
Baumann et al.²³23 . Baumann P, Nyman J, Lax I, Friesland S, Hoyer M, Rehn Ericsson S, et al. 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. Acta Oncol. 2006;45(7):787-95. http://dx.doi.org/10.1080/02841860600904862 http://dx.doi.org/10.1080/02841860600904...	57	3 × 15 Gy	peripheral	92% (3 years)	grade 3: 28% grade 4: 1.7%
Senthi et al.²⁴24 . Senthi S, Lagerwaard FJ, Haasbeek CJ, Slotman BJ, Senan S. Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: a retrospective analysis. Lancet Oncol. 2012;13(8):802-9. http://dx.doi.org/10.1016/S1470-2045(12)70242-5 http://dx.doi.org/10.1016/S1470-2045(12)...	676	3-8 fractions (54-60 Gy)	both	89% (5 years)	-
Timmerman et al.¹⁸18 . Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. 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(30):4833-9. http://dx.doi.org/10.1200/JCO.2006.07.5937 http://dx.doi.org/10.1200/JCO.2006.07.59...	70	3 × 20-22 Gy	both	95% (2 years)	pneumonitis, in 6%; rib fractures, in 3%
Brown et al.²⁵25 . Brown WT, Wu X, Fayad F, Fowler JF, Amendola BE, García S, et al. CyberKnife radiosurgery for stage I lung cancer: results at 36 months. Clin Lung Cancer. 2007;8(8):488-92. http://dx.doi.org/10.3816/CLC.2007.n.033 http://dx.doi.org/10.3816/CLC.2007.n.033...	59	1-5 fractions (15.0-67.5 Gy)	both	disease-free survival, 90%	grade 3: pneumonitis, in 7%
Van der Voort et al.²⁶26 . Van der Voort van Zyp NC, Prévost J-B, Hoogeman MS, Praag J, van der Holt B, Levendag PC, et al. Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: clinical outcome. Radiother Oncol. 2009;91(3):296-300. http://dx.doi.org/10.1016/j.radonc.2009.02.011 http://dx.doi.org/10.1016/j.radonc.2009....	70	3 × 12-15 Gy	peripheral	96% (2 years if dose was = 60 Gy)	late toxicity, in 10%

Study	Number of patients	Tumor	Dose	Local control	Survival
Haasbeek et al.³⁶36 . Haasbeek CJ, Lagerwaard FJ, Slotman BJ, Senan S. Outcomes of stereotactic ablative radiotherapy for centrally located early-stage lung cancer. J Thorac Oncol. 2011;6(12):2036-43. http://dx.doi.org/10.1097/JTO.0b013e31822e71d8 http://dx.doi.org/10.1097/JTO.0b013e3182...	63	NSCLC (T1-3N0M0)	60 Gy (8 fxs)	92.6% (5 years)	DFS: 71% OS: 49.5% (5 years)
Nuyttens et al.³⁷37 . Nuyttens JJ, van der Voort van Zyp NC, Praag J, Aluwini S, van Klaveren RJ, Verhoef C, et al. Outcome of four-dimensional stereotactic radiotherapy for centrally located lung tumors. Radiother Oncol. 2012;102(3):383-7. http://dx.doi.org/10.1016/j.radonc.2011.12.023 http://dx.doi.org/10.1016/j.radonc.2011....	56	NSCLC: 69.6%; metastatic NSCLC: 30.4%	45-60 Gy (5 fxs); 48 Gy (6 fxs)	76% (2 years)	CSS: 80% (3 years) OS: 60% (2 years)
Rowe et al.³⁸38 . Rowe BP, Boffa DJ, Wilson LD, Kim AW, Detterbeck FC, Decker RH. Stereotactic body radiotherapy for central lung tumors. J Thorac Oncol. 2012;7(9):1394-9. http://dx.doi.org/10.1097/JTO.0b013e3182614bf3 http://dx.doi.org/10.1097/JTO.0b013e3182...	47	NSCLC: 59%; metastatic NSCLC: 41%	50 Gy (4 fxs)^a	2 local failures	PFS: 24% (2 years)
Oshiro et al.³⁹39 . Oshiro Y, Aruga T, Tsuboi K, Marino K, Hara R, Sanayama Y, et al. Stereotactic body radiotherapy for lung tumors at the pulmonary hilum. Strahlenther Onkol. 2010;186(5):274-9. http://dx.doi.org/10.1007/s00066-010-2072-y http://dx.doi.org/10.1007/s00066-010-207...	21	recurrent or metastatic NSCLC: 95%	25-39 Gy (1-10 fxs)	60% (2 years)	OS: 62.2% (2 years)
Unger et al.⁴⁰40 . Unger K, Ju A, Oermann E, Suy S, Yu X, Vahdat S, et al. CyberKnife for hilar lung tumors: report of clinical response and toxicity. J Hematol Oncol. 2010;3:39. http://dx.doi.org/10.1186/1756-8722-3-39 http://dx.doi.org/10.1186/1756-8722-3-39...	20	metastatic NSCLC: 85%; hilar/main bronchial lesions	30-40 Gy (5 fxs)	63% (1 year)	OS: 54% (1 year)
Milano et al.⁴¹41 . Milano MT, Chen Y, Katz AW, Philip A, Schell MC, Okunieff P. Central thoracic lesions treated with hypofractionated stereotactic body radiotherapy. Radiother Oncol. 2009;91(3):301-6. http://dx.doi.org/10.1016/j.radonc.2009.03.005 http://dx.doi.org/10.1016/j.radonc.2009....	53	NSCLC: 66%; metastatic NSCLC: 37%	20-55 Gy (1-18 fxs)	73% (2 years)	OS: 44% (2 years); T1-2: 72%
Chang et al.⁴²42 . Chang JY, Balter PA, Dong L, Yang Q, Liao Z, Jeter M, et al. Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008;72(4):967-71. http://dx.doi.org/10.1016/j.ijrobp.2008.08.001 http://dx.doi.org/10.1016/j.ijrobp.2008....	27	T1-2 NSCLC: 48%; recurrent NSCLC: 52%	40-50 Gy (5 fxs)	3 failures (40 Gy)	-

Study	Deaths	Grade 3 toxicitya
Study	Deaths	Acute	Late
Haasbeek et al.³⁶36 . Haasbeek CJ, Lagerwaard FJ, Slotman BJ, Senan S. Outcomes of stereotactic ablative radiotherapy for centrally located early-stage lung cancer. J Thorac Oncol. 2011;6(12):2036-43. http://dx.doi.org/10.1097/JTO.0b013e31822e71d8 http://dx.doi.org/10.1097/JTO.0b013e3182...	cardiac death: 1; respiratory failure: 1	1	4
Nuyttens et al.³⁷37 . Nuyttens JJ, van der Voort van Zyp NC, Praag J, Aluwini S, van Klaveren RJ, Verhoef C, et al. Outcome of four-dimensional stereotactic radiotherapy for centrally located lung tumors. Radiother Oncol. 2012;102(3):383-7. http://dx.doi.org/10.1016/j.radonc.2011.12.023 http://dx.doi.org/10.1016/j.radonc.2011....	-	4	6
Rowe et al.³⁸38 . Rowe BP, Boffa DJ, Wilson LD, Kim AW, Detterbeck FC, Decker RH. Stereotactic body radiotherapy for central lung tumors. J Thorac Oncol. 2012;7(9):1394-9. http://dx.doi.org/10.1097/JTO.0b013e3182614bf3 http://dx.doi.org/10.1097/JTO.0b013e3182...	bronchial necrosis: 1	4
Oshiro et al.³⁹39 . Oshiro Y, Aruga T, Tsuboi K, Marino K, Hara R, Sanayama Y, et al. Stereotactic body radiotherapy for lung tumors at the pulmonary hilum. Strahlenther Onkol. 2010;186(5):274-9. http://dx.doi.org/10.1007/s00066-010-2072-y http://dx.doi.org/10.1007/s00066-010-207...	hemoptysis: 1	0	2
Unger et al.⁴⁰40 . Unger K, Ju A, Oermann E, Suy S, Yu X, Vahdat S, et al. CyberKnife for hilar lung tumors: report of clinical response and toxicity. J Hematol Oncol. 2010;3:39. http://dx.doi.org/10.1186/1756-8722-3-39 http://dx.doi.org/10.1186/1756-8722-3-39...	bronchial fistula: 1	1	0
Milano et al.⁴¹41 . Milano MT, Chen Y, Katz AW, Philip A, Schell MC, Okunieff P. Central thoracic lesions treated with hypofractionated stereotactic body radiotherapy. Radiother Oncol. 2009;91(3):301-6. http://dx.doi.org/10.1016/j.radonc.2009.03.005 http://dx.doi.org/10.1016/j.radonc.2009....	bronchial/tracheal lesion: 4	0	1
Chang et al.⁴²42 . Chang JY, Balter PA, Dong L, Yang Q, Liao Z, Jeter M, et al. Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008;72(4):967-71. http://dx.doi.org/10.1016/j.ijrobp.2008.08.001 http://dx.doi.org/10.1016/j.ijrobp.2008....	-	1

Study	Number of lesions/Number of patients	Dose
Xia et al.⁴⁴44 . Xia T, Li H, Sun Q, Wang Y, Fan N, Yu Y, et al. Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2006;66(1):117-25. http://dx.doi.org/10.1016/j.ijrobp.2006.04.013 http://dx.doi.org/10.1016/j.ijrobp.2006....	9/43	50 Gy/10 fxs
Guckenberger et al.⁴⁵45 . Guckenberger M, Wulf J, Mueller G, Krieger T, Baier K, Gabor M, et al. Dose-response relationship for image-guided stereotactic body radiotherapy of pulmonary tumors: relevance of 4D dose calculation. Int J Radiat Oncol Biol Phys. 2009;74(1):47-54. http://dx.doi.org/10.1016/j.ijrobp.2008.06.1939 http://dx.doi.org/10.1016/j.ijrobp.2008....	22/159	48 Gy/8 fxs 26.0-37.5 Gy/1-3 fxs
Baba et al.⁴³43 . Baba F, Shibamoto Y, Ogino H, Murata R, Sugie C, Iwata H, et al. Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size. Radiat Oncol. 2010;5:81. http://dx.doi.org/10.1186/1748-717X-5-81 http://dx.doi.org/10.1186/1748-717X-5-81...	29/124	44-52 Gy/4 fxs
Olsen et al.⁴⁶46 . Olsen JR, Robinson CG, El Naqa I, Creach KM, Drzymala RE, Bloch C, et al. Dose-response for stereotactic body radiotherapy in early-stage non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;81(4):e299-303. http://dx.doi.org/10.1016/j.ijrobp.2011.01.038 http://dx.doi.org/10.1016/j.ijrobp.2011....	19/130	45-50 Gy/5 fxs 54 Gy/3 fxs
Takeda et al.⁴⁷47 . Takeda A, Kunieda E, Ohashi T, Aoki Y, Koike N, Takeda T. Stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer and other primary cancers in comparison with primary lung cancer. Radiother Oncol. 2011;101(2):255-9. http://dx.doi.org/10.1016/j.radonc.2011.05.033 http://dx.doi.org/10.1016/j.radonc.2011....	33/232	50 Gy/5 fxs
Stephans et al.⁴⁸48 . Stephans KL, Djemil T, Reddy CA, Gajdos SM, Kolar M, Mason D, et al. 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(8):976-82. http://dx.doi.org/10.1097/JTO.0b013e3181adf509 http://dx.doi.org/10.1097/JTO.0b013e3181...	7/94	50 Gy/5 fxs 60 Gy/3 fxs
Janssen et al.⁴⁹49 . Janssen S, Dickgreber NJ, Koenig C, Bremer M, Werner M, Karstens JH, et al. Image-guided hypofractionated small volume radiotherapy of non-small cell lung cancer - feasibility and clinical outcome. Onkologie. 2012;35(7-8):408-12. http://dx.doi.org/10.1159/000340064 http://dx.doi.org/10.1159/000340064...	29/65	40-48 Gy/8 fxs 37.5 Gy/3 fxs
fxs: fractions.

[1] Correspondence to: Heloisa de Andrade Carvalho. Rua Dona Adma Jafet, 91, CEP 01308-050, São Paulo, SP, Brasil. Tel.: 55 11 3394-5367. E-mail:heloisa.carvalho@hc.fm.usp.br

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Abstract