Stereotactic body radiotherapy for pulmonary metastases
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· R.-J. Oh · H. Shiomi · N. Masai · H. Miura Miyakojima IGRT Clinic, Osaka University, Osaka
Stereotactic body radiotherapy for pulmonary metastases Prognostic factors and adverse respiratory events
Chemotherapy is the first line treatment for pulmonary metastases. Surgery is also indicated in selected cases with long disease-free intervals, whose pulmonary lesion was solitary and resectable. According to long-term results based on 5,206 cases from the International Registry of Lung Metastases, lung metastatectomy was a safe and potentially curative procedure [38]. Patients with pulmonary metastases from carcinoma of the intestine, kidney, uterine cervix, and uterine body are good candidates for surgical treatment. On the other hand, technical innovations in stereotactic body radiotherapy (SBRT) have been recently achieved [8]. In addition, advanced radiotherapy technologies such as intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (IMRT-SIB) and adaptive re-planning twice during the treatment course (ART) also result in better tumor control [7]. SBRT has also been indicated for selected patients with pulmonary metastases. Treatment results seem comparable to those obtained by surgical metastatectomy [38]. Over a period of 4 years, 87 patients of pulmonary metastases with SBRT were treated at our hospital with many patients being referred from outside hospitals. Technically, an in-house Air-Bag system to reduce intrafractional respiratory organ motion was developed. The aim of this retrospective study was to evaluate the feasibility, safety, and effec-
tiveness of SBRT for pulmonary metastases.
Patients and methods Between April 2007 and March 2011, 87 metastatic lung cancer patients who underwent SBRT were included in this study. Carcinoma of the intestine (n=37) was the most common primary lesion, followed by carcinoma of the breast (12), head and neck (9), liver (7), kidney (6), and bone and soft tissue sarcoma (5). These six lesions accounted for around 85% of all diseases of this study. The others were testis (3), urinary bladder (3), esophagus (2), uterus (2), thyroid (1), ovary (1), and malignant melanoma of the skin (1). There were 51 men and 36 women with a median age of 63 years (range 34– 88 years). According to ECOG performance status (PS), 40 patients were classified as PS 0, 44 as PS 1, 2 as PS 2, 1 as PS 3. Median time from the initial treatment to SBRT was 37 months (range 5–229 months). Twenty-four patients had a single pulmonary metastasis, while the remaining 63 patients had multiple pulmonary metastases. Forty patients had visceral metastases other than those in the lung. The primary lesions for 76 patients were controlled, while those for the remaining 11 patients were not controlled. Eleven patients had double primary can-
cers, and another two had triple primary cancers. As to the location of the 189 lesions, they were divided into 88 lesions in upper lobes, 12 lesions in middle lobes, and 89 lesions in lower lobes. Based on the 5-year relative survival rates for
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