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Optimizing SABR delivery for synchronous multiple lung tumors using volumetric-modulated arc therapy
Hilâl Tekatli1, Shyama U Tetar1, Timothy K Nguyen2
1a Department of Radiation Oncology , VU University Medical Center , Amsterdam , The Netherlands.
Acta Oncologica (Stockholm, Sweden)
|March 31, 2017
Summary
Stereotactic ablative radiotherapy (SABR) using volumetric-modulated arc therapy (VMAT) for multiple lung tumors is safe and effective. This approach allows for faster treatments with uncommon severe toxicity, though further planning parameter research is needed for more complex cases.
Area of Science:
- Radiation Oncology
- Medical Physics
Background:
- Volumetric-modulated arc therapy (VMAT) enables faster stereotactic ablative radiotherapy (SABR) for multiple lung tumors.
- This study reports on clinical outcomes and treatment planning strategies for VMAT-based SABR.
Purpose of the Study:
- To evaluate the clinical outcomes of VMAT-based SABR for multiple lung tumors.
- To describe a general approach for treatment planning in these cases.
- To identify factors predicting clinical outcomes.
Main Methods:
- Retrospective analysis of 84 patients with ≥2 lung lesions treated between 2009-2014.
- VMAT-based SABR delivered using separate iso-centers for distant lesions.
- Treatment involved single or fractionated doses (34 Gy, 3x18 Gy, 5x11 Gy, or 8x7.5 Gy).
- Multivariable analysis assessed predictors of clinical outcomes.
Main Results:
- Overall survival was 27.6 months for primary tumors and not reached for metastases.
- Grade ≥3 toxicity occurred in only 2% of patients.
- Radiation pneumonitis (Grade ≥2) was predicted by total lung V35Gy ≥6.5% (p=0.007).
Conclusions:
- VMAT-based SABR for up to three lung tumors is associated with uncommon severe toxicity.
- Further research into planning parameters is warranted for patients with more than three lesions.