Radiosurgery Offers Palliative Care for Hilar Lung Tumors

A new study suggests that radiosurgery could provide a new treatment option for potentially morbid, inoperable hilar tumors.

Researchers at Georgetown University Medical Center (Washington, DC, USA) reviewed the medical records of 24 patients diagnosed with hilar lung tumors--four with inoperable primary hilar lung tumors and 20 with hilar tumors that had spread there from other primary sites. All the patients in the study were treated with five courses of radiotherapy using the CyberKnife radiosurgery system. The mean radiation dose administered to the esophagus was 27 Gy, and the mean radiation dose administered to the lung was 45 Gy. Imaging studies with a combined positron emission tomography/computerized tomography (PET/CT) scan were performed at three and six-month follow-up intervals to track tumor progression.

The results showed that at one-year, the overall survival was 61%, and that most deaths were attributed to the spread of the patients' cancers. However, there was one death that was attributed to an opening in the mainstem bronchus in a patient who had been previously stented. While no uniform data was collected from patients about quality of life at the time of their treatment, the researchers claimed that the patient records reflect comments made by patients about their symptoms. The study was presented at the annual meeting of the American College of Chest Physicians, held during November 2010 in Vancouver (BC, Canada).

"Patients reported improvement with coughing, breathing, and they reported less pain,” said lead author oncologist Brian Collins, M.D. "We'd like to investigate outcomes with increased radiation doses to see if we can improve local control and overall survival rates. And we'd like to study the impact of administering a drug to make the tumors more sensitive to radiation.”

The CyberKnife is a frameless robotic radiosurgery system composed of two main elements - a small linear particle accelerator and a robotic arm, which allows the energy to be directed at any part of the body from any direction. Staged CyberKnife radiosurgery is of particular benefit to patients who have previously received large doses of conventional radiation therapy and patients with gliomas located near critical areas of the brain; unlike whole brain radiotherapy, which must be administered daily over several weeks, radiosurgery treatment can usually be completed in 1-5 treatment sessions. The CyberKnife system is a product of Accuray (Sunnyvale, CA, USA).

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Georgetown University Medical Center
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