Early stage NSCLC treatment with image guided robotic stereotactic radiosurgery

Hua Shao, PhD, Xiaodong Wu, PhD, Jun Yang, PhD, De la Zerda, Alberto, PhD, University of Miami, Miami, FL

Lung Cancer is the leading cause of cancer death in the United States. Non-small cell lung cancer (NSCLC) accouts for 80 ~ 90% of the lung cancer cases. Image guided robotic stereotactic radiosurgery localizes in real-time the tumor’s movement due to patient respiration and delivers very high dose of radiation accurately to the lung tumor. It provides one more modality to treat non-operable early stages NSCLC patients. Our 2-year preliminary clinical practice shows very favorable results.

Eligible patients include inoperable NSCLC patients or patients who refuse surgery. Around two weeks before the treatment, all patients underwent CT-guided fiducial marker placement in the tumor for image guided targeting. The fiducial is identified in the real-time X-ray images during the treatment. The robotic radiosurgery system models patient respiration according to the X-ray images and tracks in real-time tumor movement. The Linac is held by the robot and follows tumor movement and simultaneously delivers the radiation to the target. Treatments were delivered typically in three fractions of 20 Gy each.

From December 2003 to February 2006, 17 stage I and 23 stage II NSCLC patients were treated at the Cyberknife Center of Miami. Of the 17 stage I patients, 12 were followed and show no evidence of disease. Of the 23 stage II patients 14 were followed, 10 show no evidence of disease, 2 are stable with disease and 2 expired of unknown causes. Minimal complications have been observed. The typical complaint was fatigue.