Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Clinical outcome of fiducial-less CyberKnife radiosurgery for stage I non-small cell lung cancer

  • Jung, In-Hye (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Si Yeol (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Jinhong (Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Cho, Byungchul (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwak, Jungwon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Je, Hyoung Uk (Department of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Choi, Wonsik (Department of Radiation Oncology, Gangneung Asan Hospital, Uiversity of Ulsan College of Medicine) ;
  • Jung, Nuri Hyun (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Su Ssan (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun Kyung (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2015.03.13
  • Accepted : 2015.05.15
  • Published : 2015.06.30
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Abstract

Purpose: To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS). Materials and Methods: From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21. Results: The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression. Conclusion: The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

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References

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