3 augustus 2012: Lees ook: Cyberknife - opereren met robot - is uitstekende manier om beginnende longkanker succesvol te behandelen. zelfs met beperkte uitzaaiïngen

6 oktober 2009: Bron: International Radiation Oncology

Stereotactische bestraling van inoperabele longkankerpatienten met niet uitgezaaide niet-klein-cellige longkanker graad I en II maar dus wel inoperabel zorgt voor uitstekend effect op langdurige overleving. Aldus een fase II studie met langjarige follow-up.  Regionaal (lymfklieren) en recidief op afstand vond plaats bij respectievelijk 6 (8.6%) en 9 (12.9%) patienten. .Voor niet-kleincelige longkanker een uitstekend resultaat. Een andere studie bewijst dat stereo-tactische bestraling ook uitstekend werkt bij longtumoren niet groter dan 2 cm. De 3-jaars en 5-jaars overall overleving voor patienten een tumorgrootte gelijk of kleiner aan 2 cm. in diameter  (n = 58) waren beide 89.8%, vergeleken met 60.7% en 53.1% voor patienten met tumoren groter in diameter dan 2 cm (n = 57) (p <0.0005), respectievelijk. Hier de twee abstracten van de studies, recent gepubliceerd in International Radiation Oncology.

 

Stereotactic Body Radiation Therapy for Early-Stage Non–Small-Cell Lung Carcinoma: Four-Year Results of a Prospective Phase II Study

 

Achilles J. Fakiris, M.D.Corresponding Author Informationemail address, Ronald C. McGarry, M.D., Ph.D., Constantin T. Yiannoutsos, Ph.D., Lech Papiez, Ph.D.§, Mark Williams, M.D., Mark A. Henderson, M.D., Robert Timmerman, M.D.§

 

Received 4 September 2008; received in revised form 24 November 2008; accepted 27 November 2008. published online 02 March 2009.
Purpose
The 50-month results of a prospective Phase II trial of stereotactic body radiation therapy (SBRT) in medically inoperable patients are reported.
Methods and Materials
A total of 70 medically inoperable patients had clinically staged T1 (34 patients) or T2 (36 patients) (≤7 cm), N0, M0, biopsy-confirmed non–small-cell lung carcinoma (NSCLC) and received SBRT as per our previously published reports. The SBRT treatment dose of 60-66 Gy was prescribed to the 80% isodose volume in three fractions.
Results
Median follow-up was 50.2 months (range, 1.4–64.8 months). Kaplan-Meier local control at 3 years was 88.1%. Regional (nodal) and distant recurrence occurred in 6 (8.6%) and 9 (12.9%) patients, respectively. Median survival (MS) was 32.4 months and 3-year overall survival (OS) was 42.7% (95% confidence interval [95% CI], 31.1–54.3%). Cancer-specific survival at 3 years was 81.7% (95% CI, 70.0–93.4%). For patients with T1 tumors, MS was 38.7 months (95% CI, 25.3–50.2) and for T2 tumors MS was 24.5 months (95% CI, 18.5–37.4) (p = 0.194). Tumor volume (≤5 cc, 5–10 cc, 10–20 cc, >20 cc) did not significantly impact survival: MS was 36.9 months (95% CI, 18.1–42.9), 34.0 (95% CI, 16.9–57.1), 32.8 (95% CI, 21.3–57.8), and 21.4 months (95% CI, 17.8–41.6), respectively (p = 0.712). There was no significant survival difference between patients with peripheral vs. central tumors (MS 33.2 vs. 24.4 months, p = 0.697). Grade 3 to 5 toxicity occurred in 5 of 48 patients with peripheral lung tumors (10.4%) and in 6 of 22 patients (27.3%) with central tumors (Fisher's exact test, p = 0.088).
Conclusion
Based on our study results, use of SBRT results in high rates of local control in medically inoperable patients with Stage I NSCLC.
 
Clinical Outcomes of Stereotactic Body Radiotherapy for Small Lung Lesions Clinically Diagnosed as Primary Lung Cancer on Radiologic Examination

 

Tetsuya Inoue, M.D., Shinichi Shimizu, M.D., Rikiya Onimaru, M.D., Atsuya Takeda, M.D., Hiroshi Onishi, M.D., Yasushi Nagata, M.D.§, Tomoki Kimura, M.D., Katsuyuki Karasawa, M.D., Takuro Arimoto, M.D.#, Masato Hareyama, M.D., Eiki Kikuchi, M.D.††, Hiroki Shirato, M.D.Corresponding Author Informationemail address

 

Received 21 August 2008; received in revised form 17 November 2008; accepted 20 November 2008. published online 23 February 2009.
Purpose
Image-guided biopsy occasionally fails to diagnose small lung lesions, which are highly suggestive of primary lung cancer. The aim of the present study was to evaluate the outcome of stereotactic body radiotherapy (SBRT) for small lung lesions that were clinically diagnosed as primary lung cancer without pathologic confirmation.
Methods and Materials
A total of 115 patients were treated with SBRT in 12 institutions. Tumor size ranged from 5 to 45 mm in diameter, with a median of 20 mm.
Results
The 3-year and 5-year overall survival rates for patients with a tumor size ≤20 mm in diameter (n = 58) were both 89.8%, compared with 60.7% and 53.1% for patients with tumors >20 mm (n = 57) (p <0.0005), respectively. Local progression occurred in 2 patients (3.4%) with a tumor size ≤20 mm and in 3 patients (5.3%) with tumors >20 mm. Among the patients with a tumor size ≤20 mm, Grade 2 pulmonary complications were observed in 2 (3.4%), but no Grade 3 to 5 toxicity was observed. In patients with a tumor size >20 mm, Grades 2, 3, and 5 toxicity were observed in 5 patients (8.8%), 3 patients (5.3%), and 1 patient (1.8%), respectively.
Conclusion
In patients with a tumor ≤20 mm in diameter, SBRT was reasonably safe in this retrospective study. The clinical implications of the high local control rate depend on the accuracy of clinical/radiologic diagnosis for small lung lesions and are to be carefully evaluated in a prospective study.
 

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