Purpose: Stereotactic body radiation therapy (SBRT) has emerged as a standard treatment modality for medically inoperable early-stage lung cancer patients. The aim of this paper is to calculate radiobiological parameters for a sample of 39 patients who underwent lung SBRT. Materials and Methods: For SBRT, a typical regimen of 50 Gy in 4 - 5 fractions results in local tumor control rates around 99.9%. We calculate dose volume histograms (DVHs) of targeted tumors and organs at risk for 39 patients. All patients received 4D imaging, and their internal treatment volumes (ITVs) were created by phase-based sorting of multiple CT datasets. Planning target volume (PTV) diameters ranged from 2.0 to 5.7 cm. The DVHs for the PTV and organs at risk were analyzed using a Biosuite algorithm to calculate the equivalent uniform dose (EUD), tumor control probability (TCP) via a Poisson model, and normal tissue complication probability (NTCP) via an LKB model. The radiobiological effects were analyzed by correlating EUD and TCP with PTV volumes. Results: The mean PTV volume was 31.60 ± 25.55 cc. The mean EUDs were 5.19 ± 2.84, 5.66 ± 4.95, 61.45 ± 29.18, 3.31 ± 5.92, 6.45 ± 5.18, and 12.22 ± 5.94 Gy for lungs, spinal cord, chest/ribs, heart, esophagus, and skin, respectively. On average, the heart had the lowest EUD and the chest/ribs had the highest (61.45 ± 29.18 Gy). The mean NTCPs were estimated at 3.75% ± 2.61%, 36.25% ± 36.42%, and 0.59% ± 1.48%, for the lungs, chest and esophagus, respectively. The NTCPs of spinal cord, heart, and skin were 0.00%. The mean TCP value was 99.72% ± 0.44%. The mean BED value for our study was 109.49 Gy. Conclusions: We have calculated radiobiological predictors based on DVHs for early-stage non-small cell lung cancer via SBRT. Our calculated predictors are compatible with previously published SBRT reports.
References
[1]
Riess, J.W. and Wakelee, H.A. (2012) Metastatic Non-Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances. Clinical Advances in Hematology & Oncology, 10, 226-234.
[2]
Kong, F.M., Ten Haken, R.K., Schipper, M.J., Sullivan, M.A., Chen, M., Lopez, C., et al. (2005) High-Dose Radiation Improved Local Control and Overall Survival in Patients with Inoperable/Unresectable Non-Small-Cell Lung Cancer: Long-Term Results of a Radiation Dose Escalation Study. International Journal of Radiation Oncology * Biology * Physics, 63, 324-333. http://dx.doi.org/10.1016/j.ijrobp.2005.02.010
[3]
Rosenzweig, K.E., Fox, J.L., Yorke, E., Amols, H., Jackson, A., Rusch, V., et al. (2005) Results of a Phase I Dose-Escalation Study Using Three-Dimensional Conformal Radiotherapy in the Treatment of Inoperable Nonsmall Cell Lung Carcinoma. Cancer, 103, 2118-2127. http://dx.doi.org/10.1002/cncr.21007
[4]
Willner, J., Baier, K., Caragiani, E., Tschammler, A. and Flentje, M. (2002) Dose, Volume, and Tumor Control Predictions in Primary Radiotherapy of Non-Small-Cell Lung Cancer. International Journal of Radiation Oncology * Biology * Physics, 52, 382-389. http://dx.doi.org/10.1016/S0360-3016(01)01823-5
[5]
Bradley, J., Graham, M.V., Winter, K., Purdy, J.A., Komaki, R. and Roa, W.H. (2005) 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. International Journal of Radiation Oncology * Biology * Physics, 61, 318-328. http://dx.doi.org/10.1016/j.ijrobp.2004.06.260
[6]
Timmerman, R., Paulus, R., Galvin, J., Michalski, J., Straube, W., Bradley, J., Fakiris, A., Bezjak, A., Videtic, G., Johnstone, D., Fowler, J., Gore, E. and Choy, H. (2010) Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer. JAMA, 303, 1070-1076. http://dx.doi.org/10.1001/jama.2010.261
[7]
Barzi, A. and Pennell, N.A. (2010) Targeting Angiogenesis in Non-Small Cell Lung Cancer: Agents in Practice and Clinical Development. EJCMO, 2, 31-42.
[8]
Feng, F.K., Zhao, J., Wang, J. and Faivre, F.C. (2014) Radiation Dose Effect in Locally Advanced Non-Small Cell Lung Cancer. Journal of Thoracic Disease, 6, 336-347.
[9]
Mehta, N., King, C.R., Agazaryan, N., Steinberg, M., Hua, A. and Lee, P. (2012) Stereotactic Body Radiation Therapy and 3-Dimensional Conformal Radiotherapy for Stage I Non-Small Cell Lung Cancer: A Pooled Analysis of Biological Equivalent Dose and Local Control. Practical Radiation Oncology, 2, 288-295. http://dx.doi.org/10.1016/j.prro.2011.10.004
[10]
Papiez, L. and Timmerman, R. (2008) Hypofractionation in Radiation Therapy and Its Impact. Journal of Medical Physics, 35, 112-118. http://dx.doi.org/10.1118/1.2816228
[11]
Chang, B.K. and Timmerman, R.D. (2007) Stereotactic Body Radiation Therapy: A Comprehensive Review. Journal of Clinical Oncology, 30, 637-644. http://dx.doi.org/10.1097/COC.0b013e3180ca7cb1
[12]
Ding, M., Kavanagh, B.D. and Schefter, T. (2005) The Influence of Heterogeneity on Tumor and Normal Lung Dosimetry in Stereotactic Body Radiation Therapy for Lung Cancer Treatment. International Journal of Radiation Oncology * Biology * Physics, 63, S511-S512. http://dx.doi.org/10.1016/j.ijrobp.2005.07.867
[13]
Herman, T.L., Gabrish, H. and Herman, T.S. (2010) Impact of Tissue Heterogeneity Corrections in Stereotactic Body Radiation Therapy Treatment Plans for Lung Cancer. Journal of Medical Physics, 35, 170-173. http://dx.doi.org/10.4103/0971-6203.62133
[14]
Timmerman, R.D., Park, C. and Kavanagh, B.C. (2007) The North American Experience with Stereotactic Body Radiation Therapy in Non-Small Cell Lung Cancer. Journal of Thoracic Oncology, 2, 101-112.
[15]
Xiao, Y., Papiez, L. and Paulus, R. (2009) Dosimetric Evaluation of Heterogeneity Corrections for RTOG 0236: Stereotactic Body Radiotherapy of Inoperable Stage I-II Non-Small Cell Lung Cancer. International Journal of Radiation Oncology * Biology * Physics, 73, 1235-1242. http://dx.doi.org/10.1016/j.ijrobp.2008.11.019
[16]
Takeda, A., Sanuki, N. and Kunieda, E. (2009) Stereotactic Body Radiotherapy for Primary Lung Cancer at a Dose of 50 Gy Total in Five Fractions to the Periphery of the Planning Target Volume Calculated Using a Superposition Algorithm. International Journal of Radiation Oncology *Biology* Physics, 73, 442-448. http://dx.doi.org/10.1016/j.ijrobp.2008.04.043
[17]
Takahashi, W., Yamashita, H. and Saotome, N. (2012) Evaluation of Heterogeneity Dose Distributions for Stereotactic Radiotherapy (SRT): Comparison of Commercially Available Monte Carlo Dose Calculation with Other Algorithms. Journal of Radiation Oncology, 7, 20. http://dx.doi.org/10.1186/1748-717X-7-20
[18]
Onishi, H., Nagata, Y., Shirato, H., Arimoto, T., Gomi, K., Karasawa, K., Hayakawa, K., Takai, Y., Ouchi, A. and Takeda, A. (2007) Stereotactic Body Radiotherapy (SBRT, BED ≥ 100 Gy) for Operable Stage I Non-Small Cell Lung Cancer: Is SBRT Comparable to Surgery? International Journal of Radiation Oncology *Biology* Physics, 69, S86-S87.
[19]
Park, S., Urm, S. and Cho, H. (2014) Analysis of Biologically Equivalent Dose of Stereotactic Body Radiotherapy for Primary and Metastatic Lung Tumors. Cancer Research and Treatment, 46, 403-410. http://dx.doi.org/10.4143/crt.2013.168
[20]
Kong, F.-M., Zhao, J. and Wang, J.B. (2014) Corrine Faivre-Finn: Radiation Dose Effect in Locally Advanced Non-Small Cell Lung Cancer. Journal of Thoracic Disease, 6, 336-347.
[21]
Glide-Hurst, C.K., Smith, M.S., Ajlouni, M. and Chetty, I.J. (2013) Evaluation of Two Synchronized External Surrogates for 4D CT. Journal of Applied Clinical Medical Physics, 14, 4301.
[22]
Uzan, J. and Nahum, A.E. (2012) Radiobiologically Guided Optimization of the Prescription Dose and Fractionation Scheme in Radiotherapy Using BioSuite. The British Journal of Radiology, 85, 1279-1286. http://dx.doi.org/10.1259/bjr/20476567
[23]
Niemierko, A. (1997) Reporting and Analyzing Dose Distributions: A Concept of Equivalent Uniform Dose. Medical Physics, 24, 103-110. http://dx.doi.org/10.1118/1.598063
[24]
Gay, H.A. and Niemierko, A. (2007) A Free Program for Calculating EUD-Based NTCP and TCP in External Beam Radiotherapy. Medical Physics, 23, 115-125. http://dx.doi.org/10.1016/j.ejmp.2007.07.001
[25]
Lyman, J.T. (1985) Complication Probability as Assessed from Dose-Volume Histograms. Radiation Research, 8, S13-S19. http://dx.doi.org/10.2307/3583506
[26]
Lyman, J.T. and Wolbarst, A.B. (1987) Optimization of Radiation Therapy. III. A Method of Assessing Complication Probabilities from Dose-Volume Histograms. International Journal of Radiation Oncology *Biology* Physics, 13, 103-109. http://dx.doi.org/10.1016/0360-3016(87)90266-5
[27]
Kutcher, G.J. and Burman, C. (1989) Calculation of Complication Probability Factors for Non-Uniform Normal Tissue Irradiation: The Effective Volume Method. International Journal of Radiation Oncology *Biology* Physics, 16, 1623-1630. http://dx.doi.org/10.1016/0360-3016(89)90972-3
[28]
Wheldon, T.E., Deehan, C., Wheldon, E.G. and Barrett, A. (1998) The Linear-Quadratic Transformation of Dose-Volume Histograms in Fractionated Radiotherapy. Radiotherapy and Oncology, 46, 285-295. http://dx.doi.org/10.1016/S0167-8140(97)00162-X
[29]
Niemierko, A. (1999) A Generalized Concept of Equivalent Uniform Dose (EUD). Medical Physics, 26, 1100.
[30]
Luxton, G., Keall, P.J. and King, C.R. (2008) A New Formula for Normal Tissue Complication Probability (NTCP) as a Function of Equivalent Uniform Dose (EUD). Physics in Medicine and Biology, 53, 23-36. http://dx.doi.org/10.1088/0031-9155/53/1/002
[31]
Nahum, A.E. and Sanchez-Nieto, B. (2001) Tumor Control Probability Modelling: Basic Principles and Applications in Treatment Planning. Physica Medica, 17, 13-23.
[32]
Burman, C., Kutcher, G.J., Emami, B. and Goitein, M. (1991) Fitting of Normal Tissue Tolerance Data to an Analytic Function. International Journal of Radiation Oncology *Biology* Physics, 21, 123-135. http://dx.doi.org/10.1016/0360-3016(91)90172-Z
[33]
Luxton, G., Keall, P.J. and King, C.R. (2008) A New Formula for Normal Tissue Complication Probability (NTCP) as a Function of Equivalent Uniform Dose (EUD). Physics in Medicine and Biology, 53, 23-36. http://dx.doi.org/10.1088/0031-9155/53/1/002
[34]
Kim, S.S., Song, S.Y., Kwak, J., Ahn, S.D., Kim, J.H. and Lee, J.S. (2013) Clinical Prognostic Factors and Grading System for Rib Fracture Following Stereotactic Body Radiation Therapy (SBRT) in Patients with Peripheral Lung Tumors. Lung Cancer, 79, 161-166. http://dx.doi.org/10.1016/j.lungcan.2012.10.011
[35]
Uematsu, M., Shioda, A., Suda, A., Fukui, T., Ozeki, Y., Hama, Y., et al. (2001) Computed Tomography-Guided Frameless Stereotactic Radiotherapy for Stage I Nonsmall-Cell Lung Cancer: A 5-Year Experience. International Journal of Radiation Oncology *Biology* Physics, 51, 666-670. http://dx.doi.org/10.1016/S0360-3016(01)01703-5
[36]
Nambu, A., Onishi, H., Aoki, S., Tominaga, L., Kuriyama, K., Araya, M., Saito, R., Maehata, Y., Komiyama, T., Marino, K., Koshiishi, T., Sawada, E. and Araki, T. (2013) Rib Fracture after Stereotactic Radiotherapy for Primary Lung Cancer: Prevalence, Degree of Clinical Symptoms, and Risk Factors. BMC Cancer, 13, 68. http://dx.doi.org/10.1186/1471-2407-13-68
[37]
Onishi, H., Shirato, H., Nagata, Y., Hiraoka, M., Fujino, M. and Gomi, K. (2007) Hypofractionated Stereotactic Radiotherapy (Hypo-FXSRT) for Stage I Non-Small Cell Lung Cancer: Updated Results of 257 Patients in a Japanese Multi-Institutional Study. Journal of Thoracic Oncology, 2, S94-S100. http://dx.doi.org/10.1097/JTO.0b013e318074de34
[38]
Baumann, P., Nyman, J., Lax, I., Friesland, S., Hoyer, M. and Rehn, E.S. (2006) 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 Oncologica, 45, 787-795. http://dx.doi.org/10.1080/02841860600904862
[39]
Zhang, J., Yang, F., Li, B., Li, H., Liu, J., Huang, W., et al. (2011) Which Is the Optimal Biologically Effective Dose of Stereotactic Body Radiotherapy for Stage I Non-Small-Cell Lung Cancer? A Meta-Analysis. International Journal of Radiation Oncology *Biology* Physics, 81, e305-e316. http://dx.doi.org/10.1016/j.ijrobp.2011.04.034
[40]
Li, H., Zhong, H., Kim, J., et al. (2011) Investigation of the Interplay Effect between MLC and Lung Tumor Motions Using 4DCT and RPM Profile Data. Medical Physics, 38, 3692-3693. http://dx.doi.org/10.1118/1.3612838
[41]
Latifi, K., Oliver, J., Baker, R., et al. (2014) Study of 201 Non-Small Cell Lung Cancer Patients Given Stereotactic Ablative Radiation Therapy Shows Local Control Dependence on Dose Calculation Algorithm. International Journal of Radiation Oncology *Biology* Physics, 88, 1108-1113. http://dx.doi.org/10.1016/j.ijrobp.2013.12.047
[42]
Timmerman, R., McGarry, R., Yiannoutsos, C., et al. (2006) Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early Stage Lung Cancer. Journal of Clinical Oncology, 24, 4833-4839. http://dx.doi.org/10.1200/JCO.2006.07.5937
[43]
Timmerman, R.D., Kavanagh, B.D., Cho, L.C., Papiez, L. and Xing, L. (2007) Stereotactic Body Radiation Therapy in Multiple Organ Sites. Journal of Clinical Oncology, 25, 947-952. http://dx.doi.org/10.1200/JCO.2006.09.7469
[44]
Park, C., Papiez, L., Zhang, S., Story, M. and Timmerman, R.D. (2008) Universal Survival Curve and Single Fraction Equivalent Dose: Useful Tools in Understanding Potency of Ablative Radiotherapy. International Journal of Radiation Oncology *Biology* Physics, 70, 847-852. http://dx.doi.org/10.1016/j.ijrobp.2007.10.059