1 / 22

Rationale in the Single Session Treatment of Lung Tumors

Rationale in the Single Session Treatment of Lung Tumors. Markus Kufeld Christoph Fürweger, Christian Drexler Berndt Wowra, Alexander Muacevic. Indication Treatment Tracking Results. Indication. patient selection Karnofsky Score > 60 diagnosis NSCLC Stage Ia - Ib

jeffreymrobinson
Télécharger la présentation

Rationale in the Single Session Treatment of Lung Tumors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Rationale in the Single Session Treatmentof Lung Tumors Markus Kufeld Christoph Fürweger, Christian Drexler Berndt Wowra, Alexander Muacevic

  2. Indication Treatment Tracking Results

  3. Indication patient selection Karnofsky Score > 60 diagnosis NSCLC Stage Ia - Ib metastases small targets (< 4 cm max. diameter) no central lesions

  4. Treatment Parameters target definition visible tumor volume (lung window) + 6 mm target volume 15 ccm median volume min 1,5 - max 129 ccm prescription 95% Conf. Int. 24 Gy median dose 22 - 24 70 % median isodose 70 - 75 Monte Carlo since June 2008 23 cases

  5. Tracking number of lesions 10 Xsight Spine fixed paraspinal lesions 54 Synchrony fiducial tracking 10 Xsight Lung live image quality 2 x switching to marker tracking

  6. Pt. 3577 Xsight Lung

  7. Tracking fiducial placement percutaneous, CT guided one marker in the lesion complications 6 pneumothorax 11 % 3 bleedings (asymptomatic) 6 % setup Xsight Spine setup -> translation to lesion

  8. Monte Carlo 39 ray tracing 23 Monte Carlo since June 2008 physically consistent dose prescription

  9. Results patients 62 patients in 4 years 27 female 65 yrs median age (min 22 - max 87 yrs) diagnosis 22 primary NSCLC 40 metastases follow up 11 months (median, min 0,5 - max 33 mths)

  10. Results actuarial local control Interval (mths) Failures Prop. Controlled 95% Conf. Int.0 - 6 1 98 % 89.1 99.8 6 - 12 4 88 % 74.1 95.1 18 - 24 0 88 % 74.1 95.1 crude local control 92 % => 3 re-treatments (controlled)

  11. Pt. 3864spinal tracking: tumor fixed to chest wall => missed target ?

  12. Graph Local Control Results

  13. Results failures ? tumor size contouring spinal tracking Xsight Lung unknown n.s.

  14. Graph Local Control Results

  15. Results adverse events after RS CTC Grade I 24 local pneumonitis (asymptomatic) CTC Grade II1 symptomatic pneumonitis (dyspnea, cough: medication) no CTC Grade III to V toxicity

  16. Pt. 1321 NSCLC 5 months post RS (24 Gy 70 %) pre RS pre RS

  17. Results n.s.

  18. Literature McGarry, Timmerman et al. (Red Journal 2005) Phase I dose escalation study: 3 fractions 20 Gy (80 % isodose) abdominal compression

  19. Literature Hof et al. (Cancer 2007) single session 15,2 - 24 Gy (80 % isodose) abdominal compression 14 % local failure 64 % pneumonitic CT changes (CTC I + II)

  20. Literature van der Voort van Zyp, Nuyttens et al. (Green Journal 2009) 3 fractions 15 -20 Gy (70 - 85 % isodose) multiple markers similar local control, overall survival similar toxicity

  21. Images Pt. 2273NSCLC control 15 months after RS

  22. Conclusion Single session lung radiosurgery is a safe and effective treatment option for selected small tumors.

More Related