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Open Access Research

Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy

Heng-Jui Chang1, Hui-Ling Ko1, Cheng-Yen Lee1, Ren-Hong Wu1, Yu-Wung Yeh2, Jiunn-Song Jiang2, Shang-Jyh Kao2 and Kwan-Hwa Chi13*

Author Affiliations

1 Department of Radiation Therapy and Oncology, Shin-Kong Wu Ho-Su Memorial Hospital, 95, Wen-Chang Road, Shih-Lin, Taipei City, Taiwan

2 Department of Chest Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

3 Faculty of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan

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Radiation Oncology 2012, 7:222  doi:10.1186/1748-717X-7-222

Published: 27 December 2012

Abstract

Background

To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy.

Methods

Between April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy), and the median total dose was 49.5 Gy (range, 45–72 Gy). The median estimated biological effective dose at 10 Gy (BED10) was 71.8 Gy (range, 65.3–119.0 Gy), and that at 3 Gy (BED3) was 123.8 Gy (range, 112.5–233.3 Gy). The mean lung dose (MLD) was constrained mainly under 1200 cGy. The median gross tumor volume (GTV) was 27.9 cm3 (range: 2.5–178.1 cm3).

Results

The median follow-up period was 25.8 months (range, 3.0–60.7 months). The median overall survival (OS) time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD) was 11.2 months versus >50 months (not reached) in the patients without EPD (p < 0.001). Those patients with smaller GTV (≦27.9 cm3) had a better survival than those with larger GTV (>27.9 cm3): >40 months versus 12.85 months (p = 0.047). The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065). The 2-year local control (LC) rate was 94.7%. Only 2 patients (6.1%) developed ≧grade 3 radiation pneumonitis.

Conclusion

Using Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with EPD. Moreover, GTV is more significant than lesion number in predicting survival.

Keywords:
Tomotherapy; Hypofractionation; Lung cancer; Oligometastasis; Extra-pulmonary disease