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Richard I. Whyte
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Ann Thorac Surg 2003;75:1097-1101
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial

Richard I. Whyte, MDa*, Richard Crownover, MD, PhDb, Martin J. Murphy, PhDa, David P. Martin, MDa, Thomas W. Rice, MDb, Malcolm M. DeCamp, Jr, MDa, Raymond Rodebaugh, PhDb, Martin S. Weinhous, PhDb, Quynh-Thu Le, MDa

a Departments of Cardiothoracic Surgery, Neurosurgery, and Radiation Oncology, Stanford University, Stanford, California, USA
b Departments of Thoracic Surgery and Radiation Oncology, The Cleveland Clinic Medical Foundation, Cleveland, Ohio, USA

Accepted for publication October 29, 2002.

* Address reprint requests to Dr Whyte, Department of Cardiothoracic Surgery, CVRB 205, 300 Pasteur Dr, Stanford, CA94305-5407, USA
e-mail: riwhyte{at}stanford.edu

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

BACKGROUND: Stereotactic radiosurgery is well established for the treatment of intracranial neoplasms but its use for lung tumors is novel.

METHODS: Twenty-three patients with biopsy-proven lung tumors were recruited into a two-institution, dose-escalation, phase I clinical trial using a frameless stereotactic radiosurgery system (CyberKnife). Fifteen patients had primary lung tumors and 8 had metastatic tumors. The age range was 23 to 87 years (mean, 63 years). After undergoing computed tomography–guided percutaneous placement of two to four small metal fiducials directly into the tumor, patients received 1,500 cGY of radiation in a single fraction using a linear accelerator mounted on a computer-controlled robotic arm. Safety, feasibility, and efficacy were studied.

RESULTS: Nine patients were treated with a breath-holding technique, and 14 with a respiratory-gating, automated, robotic technique. Tumor size ranged from 1 to 5 cm in maximal diameter. There were four complications related to fiducial placement: three pneumothoraces requiring chest tube insertion and one emphysema exacerbation. There were no grade 3 to 5 radiation-related complications. Follow-up ranged from 1 to 26 months (mean, 7.0 months). Radiographic response was scored as complete in 2 patients, partial in 15, stable in 4, and progressive in 2. Four patients died of non–treatment-related causes at 1, 5, 9, and 11 months after radiation.

CONCLUSIONS: Single-fraction stereotactic radiosurgery is safe and feasible for the treatment of selected lung tumors. Additional studies are planned to investigate the optimal radiation dose, best motion-suppression technique, and overall treatment efficacy.




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