Question: should 12 Gy x 4 be given every other day instead of qd schedule mandated in the current RTOG study (0915)? Original Japanese studies report 12 Gy X 4 delivered in a median of 9 days if I can recall correctly. This magically becomes a daily regimen in RTOG. I am concerned about increased pulmonary complication if t SBRT is accelerated like that.
12 Gy X 4 SBRT lung schedule
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Excellent question. I had the exact same dilemma last month and I decided to go with the qod schedule. Honestly, I don't think it makes much of a difference. Once you exceed about 5 Gy or so I think classic radiobiology goes out the window.
You know, while interval between fractions doesn't matter within 12 Gy per fraction dose cloud, it may influence normal lung response within 6 Gy per fraction region (fall off area). We definitely need to see some data on this.
Think this paper was designed to investigate this specific question.
Early pulmonary toxicity following lung stereotactic body radiation therapy delivered in consecutive daily fractions☆
Michael C. Stauder, O. Kenneth Macdonald, Kenneth R. Olivier, Jason A. Call, Kyle Lafata, Charles S. Mayo, Robert C. Miller, Paul D. Brown, Heather J. Bauer, Yolanda I. Garces
Department of Radiation Oncology, Mayo Clinic, Rochester, USA
Received 30 September 2010; received in revised form 11 April 2011; accepted 11 April 2011. published online 16 May 2011.
Abstract Full Text PDF Images References
Abstract
Background and purpose
Identify the incidence of early pulmonary toxicity in a cohort of patients treated with lung stereotactic body radiation therapy (SBRT) on consecutive treatment days.
Material and methods
A total of 88 lesions in 84 patients were treated with SBRT in consecutive daily fractions (Fx) for medically inoperable non-small cell lung cancer or metastasis. The incidence of pneumonitis was evaluated and graded according to the NCI CTCAE v3.0.
Results
With a median follow-up of 15.8months (range 2.5–28.6), the median age at SBRT was 71.8years (range 23.8–87.8). 47 lesions were centrally located and 41 were peripheral. Most central lesions were treated with 48Gy in 4 Fx, and most peripheral lesions with 54Gy in 3 Fx. The incidence of grade 2 pneumonitis was 12.5% in all patients treated, and 14.3% among the subset of patients treated with 54Gy in 3 Fx. A total of two grade 3 toxicities were seen as one grade 5 toxicity in a patient treated for recurrence after pneumonectomy.
Conclusions
Treating both central and peripheral lung lesions with SBRT in consecutive daily fractions in this cohort was well tolerated and did not cause excessive early pulmonary toxicity.
Early pulmonary toxicity following lung stereotactic body radiation therapy delivered in consecutive daily fractions☆
Michael C. Stauder, O. Kenneth Macdonald, Kenneth R. Olivier, Jason A. Call, Kyle Lafata, Charles S. Mayo, Robert C. Miller, Paul D. Brown, Heather J. Bauer, Yolanda I. Garces
Department of Radiation Oncology, Mayo Clinic, Rochester, USA
Received 30 September 2010; received in revised form 11 April 2011; accepted 11 April 2011. published online 16 May 2011.
Abstract Full Text PDF Images References
Abstract
Background and purpose
Identify the incidence of early pulmonary toxicity in a cohort of patients treated with lung stereotactic body radiation therapy (SBRT) on consecutive treatment days.
Material and methods
A total of 88 lesions in 84 patients were treated with SBRT in consecutive daily fractions (Fx) for medically inoperable non-small cell lung cancer or metastasis. The incidence of pneumonitis was evaluated and graded according to the NCI CTCAE v3.0.
Results
With a median follow-up of 15.8months (range 2.5–28.6), the median age at SBRT was 71.8years (range 23.8–87.8). 47 lesions were centrally located and 41 were peripheral. Most central lesions were treated with 48Gy in 4 Fx, and most peripheral lesions with 54Gy in 3 Fx. The incidence of grade 2 pneumonitis was 12.5% in all patients treated, and 14.3% among the subset of patients treated with 54Gy in 3 Fx. A total of two grade 3 toxicities were seen as one grade 5 toxicity in a patient treated for recurrence after pneumonectomy.
Conclusions
Treating both central and peripheral lung lesions with SBRT in consecutive daily fractions in this cohort was well tolerated and did not cause excessive early pulmonary toxicity.
