TomoTherapy® SBRT for non-small cell carcinoma
The TomoTherapy® Hi·Art® system delivers precise and effective stereotactic body radiation therapy for inoperable non-small cell lung carcinoma.
CASE SUMMARY
- Institution
- Willis-Knighton Cancer Center, Shreveport, Louisiana
- Patient
- Female, 56 years
- Diagnosis
- T2, N0, M0 non-small cell carcinoma in left upper lung
- Plan
- At least 95% of PTV to receive 48 Gy
- Right lung and esophagus to receive less than 20 Gy
- Treatment
- G12 Gy x 4 fractions over 1.5 weeks
PATIENT HISTORY AND PRESENTATION
A 56-year-old nurse presented to her primary care physician with breathing trouble. Other than this condition, diagnosed as chronic obstructive pulmonary disease (COPD), the patient had no other medical problems. However, she had smoked one pack of cigarettes every day for 35 years.
Because her COPD was caused by extensive tobacco use, the patient’s physician ordered a chest X-ray. It revealed an abnormality in the lung, and a subsequent CT scan showed a very large (5.5 cm) lesion in the left upper lobe, without adenopathy.
The patient saw a pulmonologist, who performed a bronchoscopy with washings and brushings that revealed a non-small cell carcinoma favoring adenocarcinoma. A series of pulmonary tests revealed the forced expiratory volume in one second (FEV1) to be only 0.68 liters. The poor lung function ruled out the possibility of surgery. At this point, the patient was referred to oncologist Lane R. Rosen, MD, Director of Radiation Oncology at Willis-Knighton Cancer Center in Shreveport, Louisiana.
TREATMENT PLAN AND DELIVERY
Dr. Rosen did not believe traditional radiation – with historically low eradication rates – would be the best approach for such a young, healthy patient. He instead chose stereotactic body radiation therapy (SBRT).
The patient was immobilized with the Medical Intelligence BodyFIX® system. To create an extremely precise plan for delivering the radiation directly to the tumor, Dr. Rosen and his team used PET/CT images.
The patient received four doses of 12 Gy, every other day for a week and a half. Using the TomoTherapy Hi·Art treatment system’s daily CT and dose guidance capabilities, the patient was scanned twice per treatment, once prior to the first 6 Gy and again for the second 6 Gy, to ensure highly accurate alignment.
OUTCOME
The patient reported no side effects during her treatment and continued to work and function normally throughout.
Serial PET follow-up scans (below) revealed minimal FDG activity and only scar-like fibrosis with no indication of recurrence or metastatic disease. The patient reported no subsequent side effects and her lung function has since normalized.
More than three years later the patient continues to be disease free.
