Stereotactic gamma-ray body radiation therapy for asynchronous bilateral renal cell carcinoma.

PURPOSE: To preliminarily evaluate the feasibility, therapeutic effect and toxicity of stereotactic gamma-ray body radiation therapy (γ-SBRT) for asynchronous bilateral renal cell carcinoma (bRCC). MATERIALS AND METHODS: A retrospective analysis was performed on the clinical data of nine patients with asynchronous bRCC who were unable to undergo surgery and received γ-SBRT between February 2002 and May 2012. A total dose of 36-51 Gy was delivered to the 50 % isodose line covering the planning target volume at 3-5 Gy/fraction, whereas a total dose of 60-85 Gy was delivered at 5-7 Gy/fraction to the gross target volume. The local control rate (LC) and overall survival rate (OS) were calculated using the Kaplan-Meier method. RESULTS: Patient follow-up ended in March 2013 and the follow-up rate was 100 %. Of the nine patients, none presented with complete remission and five (55.6 %) achieved partial remission. The objective response rate was 55.6 %. The 1-, 3- and 5-year LC rates were 64.8, 43.2 and 43.2 %, respectively. The 1-, 3- and 5-year OS rates were 66.7, 53.3 and 35.6 %, respectively. Four (44.4 %) patients had an acute radiation reaction; there were two cases of grade I leukocytopenia and two cases of grade I gastrointestinal reactions. Late radiation-induced toxicity consisted of grade II gastrointestinal reactions in two patients. CONCLUSION: Stereotactic gamma-ray body radiation therapy was found to be safe and effective in the treatment of asynchronous bRCC. Improved prognosis will require individualised treatment and a combination of multiple therapeutic approaches; this will be a primary research trend in the future.

The application of gamma stereotactic body radiation therapy in stage I/II non-small-cell lung cancer. Promising and encouraging outcome.

OBJECTIVE: To further evaluate the efficacy and toxicity of the gamma-ray stereotactic body radiation therapy (SBRT) in patients with stage I/II non-small-cell lung cancer (NSCLC). METHODS: Twenty-nine newly diagnosed patients with stage I/II NSCLC who had no previous treatments, underwent OUR-QGD type of the gamma-SBRT at the Radiation Oncology Department, People's Liberation Army Airforce General Hospital, Beijing, China from January 2007 to July 2010. All patients were immobilized by vacuum bag, and then a slow CT scan was performed without any respiration gating. The total radiation dose of 50%, 60%, and 70% isodose line were prescribed in 50, 60, and 70 Grey (Gy) correspondingly, covering 100% of the planning target volume (PTV), 90% of the clinical target volume (CTV), and 80% of the gross target volume (GTV) in 10 fractions. The CT scans of the chest were required at one, 3, 6, 12, 18, and 24 months to evaluate the efficacy of the treatment. RESULTS: The median follow-up duration was 24 months, and the final follow-up rate is 96.6%. Local control rates of one and 2 years were all 93.1%. The progression-free survival rates versus overall survival rate of one year was 89.7% versus 96.6%, and 2 years was 86.1% versus 89.4%. Acute radiation reactions was diagnosed in 34.5%, and late radiation reactions in 37.9% of patients. CONCLUSION: The gamma-SBRT results in a good curative effects, and minimal toxicity in the treatment of stage I/II NSCLC.

Double CT imaging can measure the respiratory movement of small pulmonary tumors during stereotactic ablative radiotherapy.

PURPOSE: The purpose of this study was to investigate the application of double CT imaging to measuring the respiratory movement of small pulmonary tumors during stereotactic ablative radiotherapy (SABR). METHODS: A total of 122 small pulmonary tumors were measured in 45 patients. CT scans were conducted twice in all 122 tumors, once at the end of quiet inhalation and once at the end of exhalation. CT scans were conducted three times including at the end of quiet inhalation, at the end of exhalation and at free breathing in 36 tumors of 17 patients. The displacement of the tumor center in three directions was measured. RESULTS: The 3D motion of 122 tumors was 10.10±7.16 mm. On average, the tumors moved 1.96±2.03 mm (rang, 0-9 mm) in the X direction, 5.19±4.69 mm (rang, 0-19 mm) in the Y direction, and 7.38±6.48 mm (rang, 0-26 mm) in the Z direction. The 3D motion of tumors in the lower lung (13.00±7.64 mm) was significantly greater than that in the upper lung (7.15±5.14 mm), P<0.01. The 3D motion of the lower left lung was 16.35±7.31 mm, which was significantly greater than that of the lower right lung (11.40±7.04 mm), P<0.05. Movement in the anterior lung in the Y direction was significantly larger than in the posterior lung. The motion was 7.49±5.43 mm and 4.04±3.82 mm respectively, P<0.01. CONCLUSIONS: Double CT imaging provides accurate data for determining the outline of each target area during stereotactic ablative radiotherapy plane. The location of small pulmonary tumor foci was significantly affected by respiratory and cardiac motion.

Prospective study of epidermal growth factor receptor tyrosine kinase inhibitors concurrent with individualized radiotherapy for patients with locally advanced or metastatic non-small-cell lung cancer.

PURPOSE: To establish the safety profile and efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) concurrent with individualized radiotherapy (RT) in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Between June 2007 and January 2010, 26 patients with Stage III/IV NSCLC were enrolled in this prospective study. These patients were treated with EGFR-TKIs (gefitinib 250 mg or erlotinib 150 mg, oral daily) concurrent with individualized RT with curative intent. The thoracic RT plans were individually designed on the basis of tumor size and normal tissue volume constraints. All patients were assessed for toxicity, and 25 patients were available for efficacy. The primary endpoints were acute toxicity, overall survival, and median survival time. The secondary endpoints included local control rate, time to tumor progression, and progression-free survival (PFS). RESULTS: Median gross tumor volume, mean lung dose, and lung V20 were 56 cm(3), 8.6 Gy, and 14%, respectively. Median thoracic radiation dose was 70 Gy at a margin of gross tumor volume (range, 42-82 Gy), and median biological equivalent dose was 105 Gy (range, 60-119 Gy). Acute skin, hematologic, esophageal, and pulmonary toxicities were acceptable and manageable. Severe adverse events included neutropenia (Grade 4, 4%) and thrombocytopenia (Grade 4, 8%), esophagitis (Grade 3, 4%), and pneumonitis (Grade 3, 4%). With a median follow-up of 10.2 months, a local control rate of 96% was achieved for thoracic tumor. Median time to progression, median PFS, and median survival time were 6.3, 10.2, and 21.8 months, respectively. The 1- and 2-year PFS rates were both 42%, and 1-, 2-, and 3-year overall survival rates were 57%, 45%, and 30%, respectively. CONCLUSION: Concurrent EGFR-TKIs with individualized RT shows a favorable safety profile and promising outcome, therefore serving as a therapeutic option for patients with locally advanced or metastatic NSCLC.