skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: SU-F-T-105: The Predicted Radiation Response of Non-Small Cell Lung Cancer for SRS, SBRT and HDR Brachytherapy

Abstract

Purpose: The data on the α/β ratio of non-small cell lung cancer (NSCLC) is scarce in the literature. We have previously proposed a generalized LQ (gLQ) model to address the high dose dilemma of the LQ model. In this study, we applied the gLQ model to both the patients and in vitro cell irradiation data treated with a large range of doses, and investigated the α/β ratio in NSCLC. Methods: 150 patients with T1T2 and non-T1T2 stages were treated with stereotactic body radiotherapy (SBRT). In vitro datasets of 14 NSCLC cell lines from the National Cancer Institute published in Eur J Cancer Clin Oncol. 25(3):527–534 (1989) and 7 NSCLC cell lines published in Cancer Res 57:4285–300 (1997) were included. The gLQ model was used to fit datasets. The least χ2 method was adopted to determine the goodness of fit. Errors of the model parameters were determined by propagating minimal χ2. The α/β ratios from both the patients and these in vitro NSCLC cell lines were obtained. Results: The average of α/β ratios for T1T2 and non-T1T2 NSCLC was 1.45 Gy. The same type of cell lines irradiated with different modalities but almost the same dose rate yielded approximately the samemore » α/β ratio. The average of α/β ratios for NSCLC cell lines in this study was 5.45 Gy. Conclusion: The difference in the α/β ratios between the patients and in vitro cell data is expected and the lower α/β ratio for patients suggests the higher radiosensitivity, which could be associated with higher tumor perfusion or other tumor microenvironmental effects. The α/β ratios derived from the gLQ model can be used in high dose regions or high fraction sizes and are useful to extend our clinical experience accumulated from conversional low-dose fractionation to high dose irradiation schedules.« less

Authors:
;  [1];  [2]; ;  [3]; ;  [4]
  1. East Carolina University, Greenville, North Carolina (United States)
  2. Case Western Reserve University, Cleveland, OH (United States)
  3. Ohio State University, Columbus, OH (United States)
  4. University of Washington Medical Center, Seattle, WA (United States)
Publication Date:
OSTI Identifier:
22642350
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; BRACHYTHERAPY; DOSE RATES; LUNGS; NEOPLASMS; PATIENTS

Citation Formats

Huang, Z, Feng, Y, Lo, S, Williams, T, Grecula, J, Mayr, N, and Yuh, W. SU-F-T-105: The Predicted Radiation Response of Non-Small Cell Lung Cancer for SRS, SBRT and HDR Brachytherapy. United States: N. p., 2016. Web. doi:10.1118/1.4956241.
Huang, Z, Feng, Y, Lo, S, Williams, T, Grecula, J, Mayr, N, & Yuh, W. SU-F-T-105: The Predicted Radiation Response of Non-Small Cell Lung Cancer for SRS, SBRT and HDR Brachytherapy. United States. doi:10.1118/1.4956241.
Huang, Z, Feng, Y, Lo, S, Williams, T, Grecula, J, Mayr, N, and Yuh, W. 2016. "SU-F-T-105: The Predicted Radiation Response of Non-Small Cell Lung Cancer for SRS, SBRT and HDR Brachytherapy". United States. doi:10.1118/1.4956241.
@article{osti_22642350,
title = {SU-F-T-105: The Predicted Radiation Response of Non-Small Cell Lung Cancer for SRS, SBRT and HDR Brachytherapy},
author = {Huang, Z and Feng, Y and Lo, S and Williams, T and Grecula, J and Mayr, N and Yuh, W},
abstractNote = {Purpose: The data on the α/β ratio of non-small cell lung cancer (NSCLC) is scarce in the literature. We have previously proposed a generalized LQ (gLQ) model to address the high dose dilemma of the LQ model. In this study, we applied the gLQ model to both the patients and in vitro cell irradiation data treated with a large range of doses, and investigated the α/β ratio in NSCLC. Methods: 150 patients with T1T2 and non-T1T2 stages were treated with stereotactic body radiotherapy (SBRT). In vitro datasets of 14 NSCLC cell lines from the National Cancer Institute published in Eur J Cancer Clin Oncol. 25(3):527–534 (1989) and 7 NSCLC cell lines published in Cancer Res 57:4285–300 (1997) were included. The gLQ model was used to fit datasets. The least χ2 method was adopted to determine the goodness of fit. Errors of the model parameters were determined by propagating minimal χ2. The α/β ratios from both the patients and these in vitro NSCLC cell lines were obtained. Results: The average of α/β ratios for T1T2 and non-T1T2 NSCLC was 1.45 Gy. The same type of cell lines irradiated with different modalities but almost the same dose rate yielded approximately the same α/β ratio. The average of α/β ratios for NSCLC cell lines in this study was 5.45 Gy. Conclusion: The difference in the α/β ratios between the patients and in vitro cell data is expected and the lower α/β ratio for patients suggests the higher radiosensitivity, which could be associated with higher tumor perfusion or other tumor microenvironmental effects. The α/β ratios derived from the gLQ model can be used in high dose regions or high fraction sizes and are useful to extend our clinical experience accumulated from conversional low-dose fractionation to high dose irradiation schedules.},
doi = {10.1118/1.4956241},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To study breathing related tumor motion amplitudes by lung lobe location under controlled breathing conditions used in Stereotactic Body Radiation Therapy (SBRT) for NSCLC. Methods: Sixty-five NSCLC SBRT patients since 2009 were investigated. Patients were categorized based on tumor anatomic location (RUL-17, RML-7, RLL-18, LUL-14, LLL-9). A 16-slice CT scanner [GE RT16 Pro] along with Varian Realtime Position Management (RPM) software was used to acquire the 4DCT data set using 1.25 mm slice width. Images were binned in 10 phases, T00 being at maximum inspiration ' T50 at maximum expiration phase. Tumor volume was segmented in T50 using themore » CT-lung window and its displacement were measured from phase to phase in all three axes; superiorinferior, anterior-posterior ' medial-lateral at the centroid level of the tumor. Results: The median tumor movement in each lobe was as follows: RUL= 3.8±2.0 mm (mean ITV: 9.5 cm{sup 3}), RML= 4.7±2.8 mm (mean ITV: 9.2 cm{sup 3}), RLL=6.6±2.6 mm (mean ITV: 12.3 cm{sup 3}), LUL=3.8±2.4 mm (mean ITV: 18.5 cm{sup 3}), ' LLL=4.7±2.5 mm (mean ITV: 11.9 cm{sup 3}). The median respiratory cycle for all patients was found to be 3.81 ± 1.08 seconds [minimum 2.50 seconds, maximum 7.07 seconds]. The tumor mobility incorporating breathing cycle was RUL = 0.95±0.49 mm/s, RML = 1.35±0.62 mm/s, RLL = 1.83±0.71 mm/s, LUL = 0.98 ±0.50 mm/s, and LLL = 1.15 ±0.53 mm/s. Conclusion: Our results show that tumor displacement is location dependent. The range of motion and mobility increases as the location of the tumor nears the diaphragm. Under abdominal compression, the magnitude of tumor motion is reduced by as much as a factor of 2 in comparison to reported tumor magnitudes under conventional free breathing conditions. This study demonstrates the utility of abdominal compression in reducing the tumor motion leading to reduced ITV and planning tumor volumes (PTV)« less
  • Purpose: Quantification of volume changes on CBCT during SBRT for NSCLC may provide a useful radiological marker for radiation response and adaptive treatment planning, but the reproducibility of CBCT volume delineation is a concern. This study is to quantify inter-scan/inter-observer variability in tumor volume delineation on CBCT. Methods: Twenty earlystage (stage I and II) NSCLC patients were included in this analysis. All patients were treated with SBRT with a median dose of 54 Gy in 3 to 5 fractions. Two physicians independently manually contoured the primary gross tumor volume on CBCTs taken immediately before SBRT treatment (Pre) and after themore » same SBRT treatment (Post). Absolute volume differences (AVD) were calculated between the Pre and Post CBCTs for a given treatment to quantify inter-scan variability, and then between the two observers for a given CBCT to quantify inter-observer variability. AVD was also normalized with respect to average volume to obtain relative volume differences (RVD). Bland-Altman approach was used to evaluate variability. All statistics were calculated with SAS version 9.4. Results: The 95% limit of agreement (mean ± 2SD) on AVD and RVD measurements between Pre and Post scans were −0.32cc to 0.32cc and −0.5% to 0.5% versus −1.9 cc to 1.8 cc and −15.9% to 15.3% for the two observers respectively. The 95% limit of agreement of AVD and RVD between the two observers were −3.3 cc to 2.3 cc and −42.4% to 28.2% respectively. The greatest variability in inter-scan RVD was observed with very small tumors (< 5 cc). Conclusion: Inter-scan variability in RVD is greatest with small tumors. Inter-observer variability was larger than inter-scan variability. The 95% limit of agreement for inter-observer and inter-scan variability (∼15–30%) helps define a threshold for clinically meaningful change in tumor volume to assess SBRT response, with larger thresholds needed for very small tumors. Part of the work was funded by a Kaye award; Disclosure/Conflict of interest: Raymond H. Mak: Stock ownership: Celgene, Inc. Consulting: Boehringer-Ingelheim, Inc.« less
  • Purpose: To review treatment outcomes for stereotactic body radiotherapy (SBRT) in medically operable patients with Stage I non-small-cell lung cancer (NSCLC), using a Japanese multi-institutional database. Patients and Methods: Between 1995 and 2004, a total of 87 patients with Stage I NSCLC (median age, 74 years; T1N0M0, n = 65; T2N0M0, n = 22) who were medically operable but refused surgery were treated using SBRT alone in 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. Total dose was 45-72.5 Gy at the isocenter, administered in 3-10 fractions. Median calculated biological effective dose wasmore » 116 Gy (range, 100-141 Gy). Data were collected and analyzed retrospectively. Results: During follow-up (median, 55 months), cumulative local control rates for T1 and T2 tumors at 5 years after SBRT were 92% and 73%, respectively. Pulmonary complications above Grade 2 arose in 1 patient (1.1%). Five-year overall survival rates for Stage IA and IB subgroups were 72% and 62%, respectively. One patient who developed local recurrences safely underwent salvage surgery. Conclusion: Stereotactic body radiotherapy is safe and promising as a radical treatment for operable Stage I NSCLC. The survival rate for SBRT is potentially comparable to that for surgery.« less
  • Purpose: To assess the technical safety, adverse events, and efficacy of computed tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy in combination with regional positive lymph node intensity modulated radiation therapy in patients with locally advanced peripheral non–small cell lung cancer (NSCLC). Methods and Materials: Twenty-six patients with histologically confirmed NSCLC were enrolled in a prospective, officially approved phase 1 trial. Primary tumors were treated with HDR brachytherapy. A single 30-Gy dose was delivered to the 90% isodose line of the gross lung tumor volume. A total dose of at least 70 Gy was administered to the 95% isodose line of the planningmore » target volume of malignant lymph nodes using 6-MV X-rays. The patients received concurrent or sequential chemotherapy. We assessed treatment efficacy, adverse events, and radiation toxicity. Results: The median follow-up time was 28 months (range, 7-44 months). There were 3 cases of mild pneumothorax but no cases of hemothorax, dyspnea, or pyothorax after the procedure. Grade 3 or 4 acute hematologic toxicity was observed in 5 patients. During follow-up, mild fibrosis around the puncture point was observed on the CT scans of 2 patients, but both patients were asymptomatic. The overall response rates (complete and partial) for the primary mass and positive lymph nodes were 100% and 92.3%, respectively. The 1-year and 2-year overall survival (OS) rates were 90.9% and 67%, respectively, with a median OS of 22.5 months. Conclusion: Our findings suggest that HDR brachytherapy is safe and feasible for peripheral locally advanced NSCLC, justifying a phase 2 clinical trial.« less
  • Purpose: To review outcomes of 2 single-fraction lung stereotactic body radiation therapy (SBRT) schedules used for medically inoperable early stage lung cancer. Methods and Materials: Patients in our institution have been treated on and off protocols using single-fraction SBRT (30 Gy and 34 Gy, respectively). All patients had node-negative lung cancer measuring ≤5 cm and lying ≥2 cm beyond the trachea-bronchial tree and were treated on a Novalis/BrainLAB system with the ExactTrac positioning system for daily image guidance. Results: For the interval from 2009 to 2012, 80 patients with 82 lesions were treated with single-fraction lung SBRT. Fifty-five patients (69%) and 25 patients (31%) received 30 Gymore » and 34 Gy, respectively. In a comparison of 30 Gy and 34 Gy cohorts, patient and tumor characteristics were balanced and median follow-up in months was 18.7 and 17.8, respectively. The average heterogeneity-corrected mean doses to the target were 33.75 Gy and 37.94 Gy for the 30-Gy and 34-Gy prescriptions, respectively. Comparing 30-Gy and 34-Gy cohorts, 92.7% and 84.0% of patients, respectively, experienced no toxicity (P was not significant), and had neither grade 3 nor higher toxicities. For the 30-Gy and 34-Gy patients, rates of 1-year local failure, overall survival, and lung cancer-specific mortality were 2.0% versus 13.8%, 75.0% versus 64.0%, and 2. 1% versus 16.0%, respectively (P values for differences were not significant). Conclusions: This is the largest single-fraction lung SBRT series yet reported. and it confirms the safety, efficacy, and minimal toxicity of this schedule for inoperable early stage lung cancer.« less