Analysis of Biologically Equivalent Dose of Stereotactic Body Radiotherapy for Primary and Metastatic Lung Tumors
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PurposeThe purpose of this study was to determine the optimal biologically equivalent dose (BED)for stereotactic body radiotherapy (SBRT) by comparing local control rates in proportion tovarious total doses and fractionation schedules. Materials and MethodsThirty-four patients with early non-small-cell lung cancer and a single metastatic lung tumorwere included in this study. Differences in local control rates were evaluated according togender, primary tumor site, response, tumor size, and BED. For comparison of BEDs, theprescribed dose for SBRT was stratified according to three groups: high (BED > 146 Gy),medium to high (BED, 106 to 146 Gy), and low to medium (BED < 106 Gy). ResultsFor all patients, the overall local control rate was 85.3% at two years after treatment. Fivelocal recurrences were observed, and, notably, all of them were observed in the low tomedium BED group. Significantly higher local control rates were observed for patients witha complete response than for those with a partial response or stable disease (p < 0.001). Twenty-six patients with a tumor size of < 3 cm showed no dose-response relationship inthe low to medium, medium to high, and high BED groups, whereas eight patients with atumor size of ≥ 3 cm showed a significant dose-response relationship. The observed 2-yearlocal recurrence-free survival rates in patients with a tumor size of < 3 cm and in those witha tumor size of ≥ 3 cm were 96.2% and 50.0%, respectively, which were significantlydifferent (p=0.007). ConclusionBED > 100 Gy is required in order to achieve a > 85% local control rate regardless of tumorsize. The optimal dose for small tumors of < 3 cm appears to be within a range below 150Gy BED. Escalation of BED to high levels (> 150 Gy) may be required for patients with atumor size larger than 3 cm.
Abstract
PurposeThe purpose of this study was to determine the optimal biologically equivalent dose (BED)for stereotactic body radiotherapy (SBRT) by comparing local control rates in proportion tovarious total doses and fractionation schedules. Materials and MethodsThirty-four patients with early non-small-cell lung cancer and a single metastatic lung tumorwere included in this study. Differences in local control rates were evaluated according togender, primary tumor site, response, tumor size, and BED. For comparison of BEDs, theprescribed dose for SBRT was stratified according to three groups: high (BED > 146 Gy),medium to high (BED, 106 to 146 Gy), and low to medium (BED < 106 Gy). ResultsFor all patients, the overall local control rate was 85.3% at two years after treatment. Fivelocal recurrences were observed, and, notably, all of them were observed in the low tomedium BED group. Significantly higher local control rates were observed for patients witha complete response than for those with a partial response or stable disease (p < 0.001). Twenty-six patients with a tumor size of < 3 cm showed no dose-response relationship inthe low to medium, medium to high, and high BED groups, whereas eight patients with atumor size of ≥ 3 cm showed a significant dose-response relationship. The observed 2-yearlocal recurrence-free survival rates in patients with a tumor size of < 3 cm and in those witha tumor size of ≥ 3 cm were 96.2% and 50.0%, respectively, which were significantlydifferent (p=0.007). ConclusionBED > 100 Gy is required in order to achieve a > 85% local control rate regardless of tumorsize. The optimal dose for small tumors of < 3 cm appears to be within a range below 150Gy BED. Escalation of BED to high levels (> 150 Gy) may be required for patients with atumor size larger than 3 cm.
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