Clinical Oncology
Volume 20, Issue 9 , Pages 666-676 , November 2008

Review of Hypofractionated Small Volume Radiotherapy for Early-stage Non-small Cell Lung Cancer

  • J. Brock

      Affiliations

    • Academic Unit of Radiotherapy & Oncology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
    • Corresponding Author InformationAuthor for correspondence: J. Brock, Academic Unit of Radiotherapy & Oncology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel: +44-20-8661-3621; Fax: +44-20-8661-9211.
  • ,
  • S. Ashley

      Affiliations

    • Research and Development, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
  • ,
  • J. Bedford

      Affiliations

    • Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
    • Radiotherapy Physics, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
  • ,
  • E. Nioutsikou

      Affiliations

    • Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
  • ,
  • M. Partridge

      Affiliations

    • Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
  • ,
  • M. Brada

      Affiliations

    • Academic Unit of Radiotherapy & Oncology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
    • The Institute of Cancer Research and Lung Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK

Received 19 February 2008 ,Revised 12 May 2008 ,Accepted 12 June 2008.

References 

  1. Qiao X, Tullgren O, Lax I, Sirzen F, Lewensohn R. The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer. 2003;41(1):1–11
  2. Narayan S, Henning GT, Ten Haken RK, Sullivan MA, Martel MK, Hayman JA. Results following treatment to doses of 92.4 or 102.9 Gy on a phase I dose escalation study for non-small cell lung cancer. Lung Cancer. 2004;44(1):79–88
  3. Belderbos JS, Heemsbergen WD, De Jaeger K, Baas P, Lebesque JV. Final results of a phase I/II dose escalation trial in non-small-cell lung cancer using three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66(1):126–134
  4. Kong FM, Hayman JA, Griffith KA, et al. Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): predictors for radiation pneumonitis and fibrosis. Int J Radiat Oncol Biol Phys. 2006;65(4):1075–1086
  5. Hayman JA, Martel MK, Ten Haken RK, et al. Dose escalation in non-small-cell lung cancer using three-dimensional conformal radiation therapy: update of a phase I trial. J Clin Oncol. 2001;19(1):127–136
  6. Bradley J, Graham MV, Winter K, et al. Toxicity and outcome results of RTOG 9311: a phase I–II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys. 2005;61(2):318–328
  7. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005;23(25):5883–5891
  8. Fournel P, Robinet G, Thomas P, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Francais de Pneumo-Cancerologie NPC 95-01 study. J Clin Oncol. 2005;23(25):5910–5917
  9. Furuse K, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol. 1999;17(9):2692–2699
  10. Zatloukal P, Petruzelka L, Zemanova M, et al. Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer. 2004;46(1):87–98
  11. Saunders M, Dische S, Barrett A, Harvey A, Gibson D, Parmar M. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet. 1997;350(9072):161–165
  12. Nagata Y, Negoro Y, Aoki T, et al. Clinical outcomes of 3D conformal hypofractionated single high-dose radiotherapy for one or two lung tumors using a stereotactic body frame. Int J Radiat Oncol Biol Phys. 2002;52(4):1041–1046
  13. Wulf J, Hadinger U, Oppitz U, Thiele W, Ness-Dourdoumas R, Flentje M. Stereotactic radiotherapy of targets in the lung and liver. Strahlenther Onkol. 2001;177(12):645–655
  14. Kim DJ, Murray BR, Halperin R, Roa WH. Held-breath self-gating technique for radiotherapy of non-small-cell lung cancer: a feasibility study. Int J Radiat Oncol Biol Phys. 2001;49(1):43–49
  15. Onishi H, Kuriyama K, Komiyama T, et al. CT evaluation of patient deep inspiration self-breath-holding: how precisely can patients reproduce the tumor position in the absence of respiratory monitoring devices?. Med Phys. 2003;30(6):1183–1187
  16. Wong JW, Sharpe MB, Jaffray DA, et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys. 1999;44(4):911–919
  17. Ford EC, Mageras GS, Yorke E, Rosenzweig KE, Wagman R, Ling CC. Evaluation of respiratory movement during gated radiotherapy using film and electronic portal imaging. Int J Radiat Oncol Biol Phys. 2002;52(2):522–531
  18. Giraud P, Yorke E, Ford EC, et al. Reduction of organ motion in lung tumors with respiratory gating. Lung Cancer. 2006;51(1):41–51
  19. Brown WT, Wu X, Wen BC, et al. Early results of CyberKnife image-guided robotic stereotactic radiosurgery for treatment of lung tumors. Comput Aided Surg. 2007;12(5):253–261
  20. Wolthaus JW, Schneider C, Sonke JJ, et al. Mid-ventilation CT scan construction from four-dimensional respiration-correlated CT scans for radiotherapy planning of lung cancer patients. Int J Radiat Oncol Biol Phys. 2006;65(5):1560–1571
  21. Guckenberger M, Meyer J, Vordermark D, Baier K, Wilbert J, Flentje M. Magnitude and clinical relevance of translational and rotational patient setup errors: a cone-beam CT study. Int J Radiat Oncol Biol Phys. 2006;65(3):934–942
  22. Oelfke U, Tucking T, Nill S, et al. Linac-integrated kV-cone beam CT: technical features and first applications. Med Dosim. 2006;31(1):62–70
  23. Purdie TG, Moseley DJ, Bissonnette JP, et al. Respiration correlated cone-beam computed tomography and 4DCT for evaluating target motion in stereotactic lung radiation therapy. Acta Oncol. 2006;45(7):915–922
  24. Sidhu K, Ford EC, Spirou S, et al. Optimization of conformal thoracic radiotherapy using cone-beam CT imaging for treatment verification. Int J Radiat Oncol Biol Phys. 2003;55(3):757–767
  25. Onishi H, Kuriyama K, Komiyama T, et al. A new irradiation system for lung cancer combining linear accelerator, computed tomography, patient self-breath-holding, and patient-directed beam-control without respiratory monitoring devices. Int J Radiat Oncol Biol Phys. 2003;56(1):14–20
  26. Uematsu M, Shioda A, Suda A, et al. Intrafractional tumor position stability during computed tomography (CT)-guided frameless stereotactic radiation therapy for lung or liver cancers with a fusion of CT and linear accelerator (FOCAL) unit. Int J Radiat Oncol Biol Phys. 2000;48(2):443–448
  27. Shirato H, Shimizu S, Kunieda T, et al. Physical aspects of a real-time tumor-tracking system for gated radiotherapy. Int J Radiat Oncol Biol Phys. 2000;48(4):1187–1195
  28. Timmerman R, Galvin J, Michalski J, et al. Accreditation and quality assurance for Radiation Therapy Oncology Group: multicenter clinical trials using stereotactic body radiation therapy in lung cancer. Acta Oncol. 2006;45(7):779–786
  29. Faria SL, Bezjak A, Purdie TG, et al. Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer. Radiat Oncol. 2006;1:42
  30. Franks KN, Bezjak A, Purdie TG, et al. Early results of image-guided radiation therapy in lung stereotactic body radiotherapy (SBRT). Clin Oncol (R Coll Radiol). 2007;19(3):S10
  31. Fukumoto S, Shirato H, Shimzu S, et al. Small-volume image-guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable stage I nonsmall cell lung carcinomas. Cancer. 2002;95(7):1546–1553
  32. Hoyer M. Prospective study on stereotactic radiotherapy of limited stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2005;63(2S):S396
  33. Lee SW, Choi EK, Park HJ, et al. Stereotactic body frame based fractionated radiosurgery on consecutive days for primary or metastatic tumors in the lung. Lung Cancer. 2003;40(3):309–315
  34. Nagata Y, Takayama K, Matsuo Y, et al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys. 2005;63(5):1427–1431
  35. Onimaru R, Shirato H, Shimizu S, et al. Tolerance of organs at risk in small-volume, hypofractionated, image-guided radiotherapy for primary and metastatic lung cancers. Int J Radiat Oncol Biol Phys. 2003;56(1):126–135
  36. Onishi H, Araki T, Shirato H, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer. 2004;101(7):1623–1631
  37. Timmerman R, Papiez L, McGarry R, et al. Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Chest. 2003;124(5):1946–1955
  38. Wulf J, Haedinger U, Oppitz U, Thiele W, Mueller G, Flentje M. Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: a noninvasive treatment approach in medically inoperable patients. Int J Radiat Oncol Biol Phys. 2004;60(1):186–196
  39. Xia T, Li H, Sun Q, et al. Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable stage I/II non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2006;66(1):117–125
  40. Zimmermann FB, Geinitz H, Schill S, et al. Stereotactic hypofractionated radiotherapy in stage I (T1-2 N0 M0) non-small-cell lung cancer (NSCLC). Acta Oncol. 2006;45(7):796–801
  41. Baumann P, Nyman J, Lax I, et al. Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries. Acta Oncol. 2006;45(7):787–795
  42. Beitler JJ, Badine EA, El-Sayah D, et al. Stereotactic body radiation therapy for nonmetastatic lung cancer: an analysis of 75 patients treated over 5 years. Int J Radiat Oncol Biol Phys. 2006;65(1):100–106
  43. Uematsu M, Shioda A, Suda A, et al. Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. Int J Radiat Oncol Biol Phys. 2001;51(3):666–670
  44. Fang LC, Komaki R, Allen P, Guerrero T, Mohan R, Cox JD. Comparison of outcomes for patients with medically inoperable stage I non-small-cell lung cancer treated with two-dimensional vs. three-dimensional radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66(1):108–116
  45. Martel MK, Strawderman M, Hazuka MB, Turrisi AT, Fraass BA, Lichter AS. Volume and dose parameters for survival of non-small cell lung cancer patients. Radiother Oncol. 1997;44(1):23–29
  46. Gauden S, Ramsay J, Tripcony L. The curative treatment by radiotherapy alone of stage I non-small cell carcinoma of the lung. Chest. 1995;108(5):1278–1282
  47. Uematsu M, Sonderegger M, Shioda A, et al. Daily positioning accuracy of frameless stereotactic radiation therapy with a fusion of computed tomography and linear accelerator (focal) unit: evaluation of z-axis with a z-marker. Radiother Oncol. 1999;50(3):337–339
  48. Uematsu M, Shioda A, Tahara K, et al. Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience. Cancer. 1998;82(6):1062–1070
  49. Nyman J, Johansson KA, Hulten U. Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer—mature results for medically inoperable patients. Lung Cancer. 2006;51(1):97–103
  50. Underberg RW, Lagerwaard FJ, Slotman BJ, Cuijpers JP, Senan S. Benefit of respiration-gated stereotactic radiotherapy for stage I lung cancer: an analysis of 4dct datasets. Int J Radiat Oncol Biol Phys. 2005;62(2):554–560
  51. Giraud P, Yorke E, Jiang S, Simon L, Rosenzweig K, Mageras G. Reduction of organ motion effects in IMRT and conformal 3D radiation delivery by using gating and tracking techniques. Cancer Radiother. 2006;10(5):269–282
  52. Ruggieri R. Hypofractionation in non-small cell lung cancer (NSCLC): suggestions from modelling both acute and chronic hypoxia. Phys Med Biol. 2004;49(20):4811–4823
  53. Bortfeld T, Schlegel W. Optimization of beam orientations in radiation therapy: some theoretical considerations. Phys Med Biol. 1993;38(2):291–304
  54. Das S, Cullip T, Tracton G, et al. Beam orientation selection for intensity-modulated radiation therapy based on target equivalent uniform dose maximization. Int J Radiat Oncol Biol Phys. 2003;55(1):215–224
  55. D'Souza WD, Meyer RR, Shi L. Selection of beam orientations in intensity-modulated radiation therapy using single-beam indices and integer programming. Phys Med Biol. 2004;49(15):3465–3481
  56. Liu R, Buatti JM, Howes TL, Dill J, Modrick JM, Meeks SL. Optimal number of beams for stereotactic body radiotherapy of lung and liver lesions. Int J Radiat Oncol Biol Phys. 2006;66(3):906–912
  57. Lax I, Blomgren H, Naslund I, Svanstrom R. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol. 1994;33(6):677–683
  58. de Pooter JA, Mendez Romero A, Jansen WP, et al. Computer optimization of noncoplanar beam setups improves stereotactic treatment of liver tumors. Int J Radiat Oncol Biol Phys. 2006;66(3):913–922
  59. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56(1):83–88
  60. Kry SF, Salehpour M, Followill DS, et al. The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2005;62(4):1195–1203
  61. Guerrero M, Li XA. Extending the linear-quadratic model for large fraction doses pertinent to stereotactic radiotherapy. Phys Med Biol. 2004;49(20):4825–4835
  62. Macbeth FR, Wheldon TE, Girling DJ, et al. Radiation myelopathy: estimates of risk in 1048 patients in three randomized trials of palliative radiotherapy for non-small cell lung cancer. The Medical Research Council Lung Cancer Working Party. Clin Oncol (R Coll Radiol). 1996;8(3):176–181
  63. Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999;45(2):323–329
  64. Claude L, Perol D, Ginestet C, et al. A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis. Radiother Oncol. 2004;71(2):175–181
  65. Clenton SJ, Fisher PM, Conway J, Kirkbride P, Hatton MQ. The use of lung dose-volume histograms in predicting post-radiation pneumonitis after non-conventionally fractionated radiotherapy for thoracic carcinoma. Clin Oncol (R Coll Radiol). 2005;17(8):599–603
  66. Chang MY, Sugarbaker DJ. Surgery for early stage non-small cell lung cancer. Semin Surg Oncol. 2003;21(2):74–84
  67. Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg. 1995;109(1):120–129
  68. Naruke T, Goya T, Tsuchiya R, Suemasu K. Prognosis and survival in resected lung carcinoma based on the new international staging system. J Thorac Cardiovasc Surg. 1988;96(3):440–447
  69. Blomgren H. Radiosurgery for tumors in the body: clinical experience using a new method. J Radiosurgery. 1998;1(1):63–74
  70. Blomgren H, Lax I, Naslund I, Svanstrom R. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol. 1995;34(6):861–870
  71. Bradley JD, Graham MV, Winter K. Acute and late toxicity results of RTOG 9311: A dose escalation study using conformal radiation therapy in patients with inoperable non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2003;57(2 Suppl):S137–S138
  72. Cardenes H, Timmerman R, Papiez L. Extracranial stereotactic radioablation: Review of biological basis, technique and preliminary clinical experience. Oncologia. 2002;23(4):193–199
  73. Curran WJ, Moldofsky PJ, Solin LJ. Analysis of the influence of elective nodal irradiation on postirradiation pulmonary function. Cancer. 1990;65(11):2488–2493
  74. Krol AD, Aussems P, Noordijk EM, Hermans J, Leer JW. Local irradiation alone for peripheral stage I lung cancer: Could we omit the elective regional nodal irradiation?. Int J Radiat Oncol Biol Phys. 1996;34(2):297–302
  75. Robertson JM, Ten Haken RK, Hazuka MB, et al. Dose escalation for non-small cell lung cancer using conformal radiation therapy. Int J Radiat Oncol Biol Phys. 1997;37(5):1079–1085
  76. Slotman BJ, Antonisse IE, Njo KH. Limited field irradiation in early stage (T1-2N0) non-small cell lung cancer. Radiother Oncol. 1996;41(1):41–44
  77. Williams TE, Thomas CR, Turrisi AT. Counterpoint: better radiation treatment of non-small cell lung cancer using new techniques without elective nodal irradiation. Semin Radiat Oncol. 2000;10(4):315–323

PII: S0936-6555(08)00275-6

doi: 10.1016/j.clon.2008.06.005

Clinical Oncology
Volume 20, Issue 9 , Pages 666-676 , November 2008