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3 augustus 2012: Bron: Front Oncol. 2012;2:9. Epub 2012 Feb 1. en Front Oncol. 2012;2:63. Epub 2012 Jun 29

De cyberknife, een robot voor nauwkeurige stereo tactische bestraling van o.a. longtumoren, blijkt voor beginnende longkanker, zelfs met beperkte uitzaaiïngen een succesvolle behandeling te kunnen zijn. In beide studies blijkt de overall overleving na 4 en 2 jaar beter voor de patiënten die met de cyberknife waren behandeld dan verwacht mocht worden met een klassieke vorm van radiotherapie op basis van historische statistieken. Dit tonen de resultaten uit twee onafhankelijk van elkaar uitgevoerde langjarige studies. Wat opvalt is dat de gemiddelde leeftijd van de deelnemende patiënten in beide studies boven de 70 jaar gemiddeld ligt.

De eerste studie behandelde 40 patiënten met stadium I niet-kleincellig longkanker (NSCLC) met tumoren die eigenlijk te riskant waren om te opereren. De behandeling met de cyberknife werd uitgevoerd met een
zogeheten wig resectie met de cyberknife. Een PET/CT scan bepaalde de enscenering. De behandelingen werden uitgevoerd met behulp van de cyberknife met zogeheten tumor tracking.
Drie-tot-vijf gouden fiduciaire markers werden geïmplanteerd in of nabij tumoren en dienden als gerichte referentiepunten. Algemeen onderzoek en PET / CT beeldvorming werden elke drie maanden als follow-up uitgevoerd.

Veertig patiënten (gemiddelde leeftijd 76) met een mediane maximale tumor met een diameter van 2,6 cm (range, 1.4-5.0 cm) werden behandeld. Bij een gemiddelde follow-up van 44 maanden (range, 12-72 maanden), de 3 jaar Kaplan-Meier locoregionale controle en de totale overlevings cijfers waren in het voordeel van de patiënten behandeld met de
cyberknife in vergelijking met de hedendaagse resultaten op 91 en 75%, respectievelijk.

In de tweede studie werden 24 patiënten (gemiddelde leeftijd 73 jaar) met een gemiddelde maximale tumor met een diameter van 2,5 cm (bereik, 0,8 tot 4,5 cm) behandeld met de cyberknife. De standaardbehandeling voor operabele longkankerpatiënten met enkelvoudige perifere longmetastasen is metastasectomie - volledige verwijdering.
De patienten werden behandeld en gevolgd gedurende een periode van 6 jaar, van september 2004 tot september 2010 en vervolgens voor minimaal 1 jaar of tot aan overlijden. De patiënten werden bestraald in drie gedeelten over een periode van 3-11 dagen (gemiddeld 7 dagen). Bij een gemiddelde follow-up van 20 maanden, was de 2-jarige Kaplan-Meier lokale
controle 87% en de algehele overleving 50%.

Conclusie van de onderzoekers: CyberKnife met de vaste tracking is een effectieve behandeling voor hoog-risico chirurgische patiënten met een klein aantal perifere longmetastasen.

Hieronder de abstracten van de volledige studierapporten: CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Single Peripheral Lung Metastases en de studie:
CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Stage I Non-Small Cell Lung Cancer

CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Stage I Non-Small Cell Lung Cancer

Front Oncol. 2012; 2 : 9.

Published online 2012 February 1. doi: 10.3389/fonc.2012.00009

PMCID: PMC3356163

CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Stage I Non-Small Cell Lung Cancer

Viola J. Chen,¹ Eric Oermann,¹ Saloomeh Vahdat,² Jennifer Rabin,¹ Simeng Suy,¹ Xia Yu,¹ Sean P. Collins,¹ Deepa Subramaniam,³ Filip Banovac,⁴ Eric Anderson,⁵ and Brian T. Collins^1,^*

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Abstract

Published data suggests that wedge resection for stage I non-small cell lung cancer (NSCLC) is associated with improved overall survival compared to stereotactic body radiation therapy. We report CyberKnife outcomes for high-risk surgical patients with biopsy-proven stage I NSCLC. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs) were contoured using lung windows; the margins were expanded by 5mm to establish the planning treatment volume (PTV). Treatment plans were designed using a mean of 156 pencil beams. Doses delivered to the PTV ranged from 42 to 60Gy in three fractions. The 30Gy isodose contour extended at least 1cm from the GTV to eradicate microscopic disease. Treatments were delivered using the CyberKnife system with tumor tracking. Examination and PET/CT imaging occurred at 3month follow-up intervals. Forty patients (median age 76) with a median maximum tumor diameter of 2.6cm (range, 1.4–5.0cm) and a mean post-bronchodilator percent predicted forced expiratory volume in 1s (FEV1) of 57% (range, 21–111%) were treated. A median dose of 48Gy was delivered to the PTV over 3–13days (median, 7days). The 30Gy isodose contour extended a mean 1.9cm from the GTV. At a median 44months (range, 12–72months) follow-up, the 3year Kaplan–Meier locoregional control and overall survival estimates compare favorably with contemporary wedge resection outcomes at 91 and 75%, respectively. CyberKnife is an effective treatment approach for stage I NSCLC that is similar to wedge resection, eradicating tumors with 1–2cm margins in order to preserve lung function. Prospective randomized trials comparing CyberKnife with wedge resection are necessary to confirm equivalence.

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CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Single Peripheral Lung Metastases

Front Oncol. 2012; 2 : 63.

Published online 2012 June 29. doi: 10.3389/fonc.2012.00063

PMCID: PMC3386520

CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk Surgical Patients with Single Peripheral Lung Metastases

James W. Snider,¹ Eric K. Oermann,¹ Viola Chen,¹ Jennifer Rabin,¹ Simeng Suy,¹ Xia Yu,¹ Saloomeh Vahdat,² Sean P. Collins,¹ Filip Banovac,³ Eric Anderson,⁴ and Brian T. Collins^1,^*

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Abstract

Standard treatment for operable patients with single peripheral lung metastases is metastasectomy. We report mature CyberKnife outcomes for high-risk surgical patients with biopsy proven single peripheral lung metastases. Twenty-four patients (median age 73years) with a mean maximum tumor diameter of 2.5cm (range, 0.8–4.5cm) were treated over a 6-year period extending from September 2004 to September 2010 and followed for a minimum of 1year or until death. A mean dose of 52Gy (range, 45–60Gy) was delivered to the prescription isodose line in three fractions over a 3–11day period (mean, 7days). At a median follow-up of 20months, the 2-year Kaplan–Meier local control and overall survival rates were 87 and 50%, respectively. CyberKnife with fiducial tracking is an effective treatment for high-risk surgical patients with single small peripheral lung metastases. Trials comparing CyberKnife with metastasectomy for operable patients are necessary to confirm equivalence.

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