Results of multifield conformai radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams

Sanjeev Bahri, John C. Flickinger, Andre M. Kalend, Melvin Deutsch, Chandra Belani, Frank C. Sciurba, James D. Luketich, Joel S. Greenberger

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

A five-field conformal technique with three-dimensional radiation therapy treatment planning (3-DRTP) has been shown to permit better definition of the target volume for lung cancer, while minimizing the normal tissue volume receiving greater than 50% of the target dose. In an initial study to confirm the safety of conventional doses, we used the five-field conformal 3-DRTP technique. We then used the technique in a second study, enhancing the therapeutic index in a series of 42 patients, as well as to evaluate feasibility, survival outcome, and treatment toxicity. Forty-two consecutive patients with nonsmall-cell lung carcinoma (NSCLC) were evaluated during the years 1993-1997. The median age was 60 years (range 34-80). The median radiation therapy (RT) dose to the gross tumor volume was 6,300 cGy (range 5,000-6,840 cGy) delivered over 6 to 6.5 weeks in 180-275 cGy daily fractions, 5 days per week. There were three patients who received a split course treatment of 5,500 cGy in 20 fractions, delivering 275 cGy daily with a 2-week break built into the treatment course after 10 fractions. The stages of disease were II in 2%, IIIA in 40%, IIIB in 42.9%, and recurrent disease in 14.3% of the patients. The mean tumor volume was 324.14 cc (range 88.3-773.7 cc); 57.1% of the patients received combined chemoradiotherapy, while the others were treated with radiation therapy alone. Of the 42 patients, 7 were excluded from the final analysis because of diagnosis of distant metastasis during treatment. Two of the patients had their histology reinterpreted as being other than NSCLC, 2 patients did not complete RT at the time of analysis, and 1 patient voluntarily discontinued treatment because of progressive deterioration. Median follow-up was 11.2 months (range 3-32.5 months). Survival for patients with Stage III disease was 70.2% at 1 year and 51.5% at 2 years, with median survival not yet reached. Local control for the entire series was 23.3 ± 11.4% at 2 years. However, for Stage III patients, local control was 50% at 1 year and 30% at 2 years. Patients who received concurrent chemotherapy had significantly improved survival (P = 0.002) and local control (P = 0.004), compared with RT alone. Late esophageal toxicity of ≥Grade 3 occurred in 14.1 ± 9.3% of patients (3 of 20) receiving combined chemoradiotherapy, but in none of the 15 patients treated with RT alone. Pulmonary toxicity limited to Grades 1-2 occurred in 6.8% of the patients, and none developed ≥Grade 3 pulmonary toxicity. Patients with locally advanced NSCLC, who commonly have tumor volumes in excess of 200 cc, present a challenge for adequate dose delivery without significant toxicity. Our five-field conformal 3-DRTP technique, which incorporates treatment planning by dose/volume histogram (DVH) was associated with minimal toxicity and may facilitate dose escalation to the gross tumor.

Original languageEnglish (US)
Pages (from-to)297-308
Number of pages12
JournalRadiation Oncology Investigations
Volume7
Issue number5
DOIs
StatePublished - Dec 1 1999

Fingerprint

collimation
lungs
radiation therapy
Radiotherapy
cancer
Carcinoma
Lung
toxicity
dosage
tumors
Tumor Burden
grade
Survival
Chemoradiotherapy
Therapeutics
planning
histology
metastasis
chemotherapy
deterioration

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Bahri, Sanjeev ; Flickinger, John C. ; Kalend, Andre M. ; Deutsch, Melvin ; Belani, Chandra ; Sciurba, Frank C. ; Luketich, James D. ; Greenberger, Joel S. / Results of multifield conformai radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams. In: Radiation Oncology Investigations. 1999 ; Vol. 7, No. 5. pp. 297-308.
@article{d16e6f7a9d8f4b3d91e15f7f3088f498,
title = "Results of multifield conformai radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams",
abstract = "A five-field conformal technique with three-dimensional radiation therapy treatment planning (3-DRTP) has been shown to permit better definition of the target volume for lung cancer, while minimizing the normal tissue volume receiving greater than 50{\%} of the target dose. In an initial study to confirm the safety of conventional doses, we used the five-field conformal 3-DRTP technique. We then used the technique in a second study, enhancing the therapeutic index in a series of 42 patients, as well as to evaluate feasibility, survival outcome, and treatment toxicity. Forty-two consecutive patients with nonsmall-cell lung carcinoma (NSCLC) were evaluated during the years 1993-1997. The median age was 60 years (range 34-80). The median radiation therapy (RT) dose to the gross tumor volume was 6,300 cGy (range 5,000-6,840 cGy) delivered over 6 to 6.5 weeks in 180-275 cGy daily fractions, 5 days per week. There were three patients who received a split course treatment of 5,500 cGy in 20 fractions, delivering 275 cGy daily with a 2-week break built into the treatment course after 10 fractions. The stages of disease were II in 2{\%}, IIIA in 40{\%}, IIIB in 42.9{\%}, and recurrent disease in 14.3{\%} of the patients. The mean tumor volume was 324.14 cc (range 88.3-773.7 cc); 57.1{\%} of the patients received combined chemoradiotherapy, while the others were treated with radiation therapy alone. Of the 42 patients, 7 were excluded from the final analysis because of diagnosis of distant metastasis during treatment. Two of the patients had their histology reinterpreted as being other than NSCLC, 2 patients did not complete RT at the time of analysis, and 1 patient voluntarily discontinued treatment because of progressive deterioration. Median follow-up was 11.2 months (range 3-32.5 months). Survival for patients with Stage III disease was 70.2{\%} at 1 year and 51.5{\%} at 2 years, with median survival not yet reached. Local control for the entire series was 23.3 ± 11.4{\%} at 2 years. However, for Stage III patients, local control was 50{\%} at 1 year and 30{\%} at 2 years. Patients who received concurrent chemotherapy had significantly improved survival (P = 0.002) and local control (P = 0.004), compared with RT alone. Late esophageal toxicity of ≥Grade 3 occurred in 14.1 ± 9.3{\%} of patients (3 of 20) receiving combined chemoradiotherapy, but in none of the 15 patients treated with RT alone. Pulmonary toxicity limited to Grades 1-2 occurred in 6.8{\%} of the patients, and none developed ≥Grade 3 pulmonary toxicity. Patients with locally advanced NSCLC, who commonly have tumor volumes in excess of 200 cc, present a challenge for adequate dose delivery without significant toxicity. Our five-field conformal 3-DRTP technique, which incorporates treatment planning by dose/volume histogram (DVH) was associated with minimal toxicity and may facilitate dose escalation to the gross tumor.",
author = "Sanjeev Bahri and Flickinger, {John C.} and Kalend, {Andre M.} and Melvin Deutsch and Chandra Belani and Sciurba, {Frank C.} and Luketich, {James D.} and Greenberger, {Joel S.}",
year = "1999",
month = "12",
day = "1",
doi = "10.1002/(SICI)1520-6823(1999)7:5<297::AID-ROI5>3.0.CO;2-Z",
language = "English (US)",
volume = "7",
pages = "297--308",
journal = "Radiation Oncology Investigations",
issn = "1065-7541",
publisher = "John Wiley and Sons Inc.",
number = "5",

}

Results of multifield conformai radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams. / Bahri, Sanjeev; Flickinger, John C.; Kalend, Andre M.; Deutsch, Melvin; Belani, Chandra; Sciurba, Frank C.; Luketich, James D.; Greenberger, Joel S.

In: Radiation Oncology Investigations, Vol. 7, No. 5, 01.12.1999, p. 297-308.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Results of multifield conformai radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams

AU - Bahri, Sanjeev

AU - Flickinger, John C.

AU - Kalend, Andre M.

AU - Deutsch, Melvin

AU - Belani, Chandra

AU - Sciurba, Frank C.

AU - Luketich, James D.

AU - Greenberger, Joel S.

PY - 1999/12/1

Y1 - 1999/12/1

N2 - A five-field conformal technique with three-dimensional radiation therapy treatment planning (3-DRTP) has been shown to permit better definition of the target volume for lung cancer, while minimizing the normal tissue volume receiving greater than 50% of the target dose. In an initial study to confirm the safety of conventional doses, we used the five-field conformal 3-DRTP technique. We then used the technique in a second study, enhancing the therapeutic index in a series of 42 patients, as well as to evaluate feasibility, survival outcome, and treatment toxicity. Forty-two consecutive patients with nonsmall-cell lung carcinoma (NSCLC) were evaluated during the years 1993-1997. The median age was 60 years (range 34-80). The median radiation therapy (RT) dose to the gross tumor volume was 6,300 cGy (range 5,000-6,840 cGy) delivered over 6 to 6.5 weeks in 180-275 cGy daily fractions, 5 days per week. There were three patients who received a split course treatment of 5,500 cGy in 20 fractions, delivering 275 cGy daily with a 2-week break built into the treatment course after 10 fractions. The stages of disease were II in 2%, IIIA in 40%, IIIB in 42.9%, and recurrent disease in 14.3% of the patients. The mean tumor volume was 324.14 cc (range 88.3-773.7 cc); 57.1% of the patients received combined chemoradiotherapy, while the others were treated with radiation therapy alone. Of the 42 patients, 7 were excluded from the final analysis because of diagnosis of distant metastasis during treatment. Two of the patients had their histology reinterpreted as being other than NSCLC, 2 patients did not complete RT at the time of analysis, and 1 patient voluntarily discontinued treatment because of progressive deterioration. Median follow-up was 11.2 months (range 3-32.5 months). Survival for patients with Stage III disease was 70.2% at 1 year and 51.5% at 2 years, with median survival not yet reached. Local control for the entire series was 23.3 ± 11.4% at 2 years. However, for Stage III patients, local control was 50% at 1 year and 30% at 2 years. Patients who received concurrent chemotherapy had significantly improved survival (P = 0.002) and local control (P = 0.004), compared with RT alone. Late esophageal toxicity of ≥Grade 3 occurred in 14.1 ± 9.3% of patients (3 of 20) receiving combined chemoradiotherapy, but in none of the 15 patients treated with RT alone. Pulmonary toxicity limited to Grades 1-2 occurred in 6.8% of the patients, and none developed ≥Grade 3 pulmonary toxicity. Patients with locally advanced NSCLC, who commonly have tumor volumes in excess of 200 cc, present a challenge for adequate dose delivery without significant toxicity. Our five-field conformal 3-DRTP technique, which incorporates treatment planning by dose/volume histogram (DVH) was associated with minimal toxicity and may facilitate dose escalation to the gross tumor.

AB - A five-field conformal technique with three-dimensional radiation therapy treatment planning (3-DRTP) has been shown to permit better definition of the target volume for lung cancer, while minimizing the normal tissue volume receiving greater than 50% of the target dose. In an initial study to confirm the safety of conventional doses, we used the five-field conformal 3-DRTP technique. We then used the technique in a second study, enhancing the therapeutic index in a series of 42 patients, as well as to evaluate feasibility, survival outcome, and treatment toxicity. Forty-two consecutive patients with nonsmall-cell lung carcinoma (NSCLC) were evaluated during the years 1993-1997. The median age was 60 years (range 34-80). The median radiation therapy (RT) dose to the gross tumor volume was 6,300 cGy (range 5,000-6,840 cGy) delivered over 6 to 6.5 weeks in 180-275 cGy daily fractions, 5 days per week. There were three patients who received a split course treatment of 5,500 cGy in 20 fractions, delivering 275 cGy daily with a 2-week break built into the treatment course after 10 fractions. The stages of disease were II in 2%, IIIA in 40%, IIIB in 42.9%, and recurrent disease in 14.3% of the patients. The mean tumor volume was 324.14 cc (range 88.3-773.7 cc); 57.1% of the patients received combined chemoradiotherapy, while the others were treated with radiation therapy alone. Of the 42 patients, 7 were excluded from the final analysis because of diagnosis of distant metastasis during treatment. Two of the patients had their histology reinterpreted as being other than NSCLC, 2 patients did not complete RT at the time of analysis, and 1 patient voluntarily discontinued treatment because of progressive deterioration. Median follow-up was 11.2 months (range 3-32.5 months). Survival for patients with Stage III disease was 70.2% at 1 year and 51.5% at 2 years, with median survival not yet reached. Local control for the entire series was 23.3 ± 11.4% at 2 years. However, for Stage III patients, local control was 50% at 1 year and 30% at 2 years. Patients who received concurrent chemotherapy had significantly improved survival (P = 0.002) and local control (P = 0.004), compared with RT alone. Late esophageal toxicity of ≥Grade 3 occurred in 14.1 ± 9.3% of patients (3 of 20) receiving combined chemoradiotherapy, but in none of the 15 patients treated with RT alone. Pulmonary toxicity limited to Grades 1-2 occurred in 6.8% of the patients, and none developed ≥Grade 3 pulmonary toxicity. Patients with locally advanced NSCLC, who commonly have tumor volumes in excess of 200 cc, present a challenge for adequate dose delivery without significant toxicity. Our five-field conformal 3-DRTP technique, which incorporates treatment planning by dose/volume histogram (DVH) was associated with minimal toxicity and may facilitate dose escalation to the gross tumor.

UR - http://www.scopus.com/inward/record.url?scp=0032710313&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032710313&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1520-6823(1999)7:5<297::AID-ROI5>3.0.CO;2-Z

DO - 10.1002/(SICI)1520-6823(1999)7:5<297::AID-ROI5>3.0.CO;2-Z

M3 - Article

C2 - 10580899

AN - SCOPUS:0032710313

VL - 7

SP - 297

EP - 308

JO - Radiation Oncology Investigations

JF - Radiation Oncology Investigations

SN - 1065-7541

IS - 5

ER -