Stereotactic ablative radiotherapy (SABR) has emerged as a promising treatment for early stage non-small cell lung cancer, particularly for patients unable to tolerate surgical resection. High rates of local tumor control have been demonstrated with acceptable toxicity and the practical advantage of a short course of treatment. The CyberKnife image-guided robotic radiosurgery system has unique technical characteristics that make it well suited for SABR of tumors that move with breathing, including lung tumors. We review the qualities of the CyberKnife platform for lung tumor SABR, and provide a summary of clinical data using this system specifically.
JemalA.SiegelR.XuJ.WardE.Cancer Statistics, 2010. CA: A Cancer Journal for Clinicians (2010).
2.
FerlayJ.ShinH. R.BrayF.FormanD.MathersC.ParkinD.GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide, <http://globocan.iarc.fr> (2010).
3.
GoldstrawP.CrowleyJ.ChanskyK.GirouxD. J.GroomeP. A.Rami-PortaR.PostmusP. E.RuschV.SobinL.Committee I. A. f. t. S. o. L. C. I. S. Institutions P.The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol2, 706–714 (2007).
4.
AsamuraH.GoyaT.KoshiishiY.SoharaY.EguchiK.MoriM.NakanishiY.TsuchiyaR.ShimokataK.InoueH.NukiwaT.MiyaokaE.RegistryJ. J. C. o. L. C.A Japanese Lung Cancer Registry study: Prognosis of 13,010 resected lung cancers. J Thorac Oncol3, 46–52 (2008).
5.
QiaoX.TullgrenO.LaxI.SirzénF.LewensohnR.The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer41, 1–11 (2003).
6.
WisniveskyJ. P.BonomiM.HenschkeC.IannuzziM.McGinnT.Radiation therapy for the treatment of unresected stage I-II non-small cell lung cancer. Chest128, 1461–1467 (2005).
7.
KotharyN.HeitJ. J.LouieJ. D.KuoW. T.LooB. W.KoongA.ChangD. T.HovsepianD.SzeD. Y.HofmannL. V.Safety and efficacy of percutaneous fiducial marker implantation for image-guided radiation therapy. Journal of vascular and interventional radiology: JVIR20, 235–239 (2009).
8.
HongJ. C.YuY.RaoA. K.DieterichS.MaximP. G.LeQ.-T.DiehnM.SzeD. Y.KotharyN.LooB. W.High Retention and Safety of Percutaneously Implanted Endovascular Embolization Coils as Fiducial Markers for Image-Guided Stereotactic Ablative Radiotherapy of Pulmonary Tumors. Int J Radiat Oncol Biol Phys (2010).
9.
PrévostJ.-B. G.NuyttensJ. J.HoogemanM. S.PöllJ. J.van DijkL. C.PattynamaP. M. T.Endovascular coils as lung tumour markers in real-time tumour tracking stereotactic radiotherapy: Preliminary results. Eur Radiol18, 1569–1576 (2008).
10.
AnanthamD.Feller-KopmanD.ShanmughamL. N.BermanS. M.DecampM. M.GangadharanS. P.EberhardtR.HerthF.ErnstA.Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors: A feasibility study. Chest132, 930–935 (2007).
11.
BrownW. T.WuX.FayadF.FowlerJ. F.GarcíaS.MonterrosoM. I.de la ZerdaA.SchwadeJ. G.Application of robotic stereotactic radiotherapy to peripheral stage I non-small cell lung cancer with curative intent. Clin Oncol21, 623–631 (2009).
12.
LeQ.-T.LooB. W.HoA.CotrutzC.KoongA. C.WakeleeH.KeeS. T.ConstantinescuD.WhyteR. I.DoningtonJ.Results of a phase I dose-escalation study using single-fraction stereotactic radiotherapy for lung tumors. J Thorac Oncol1, 802–809 (2006).
13.
CollinsB. T.VahdatS.EricksonK.CollinsS. P.SuyS.YuX.ZhangY.SubramaniamD.ReichnerC. A.SarikayaI.EspositoG.YousefiS.Jamis-DowC.BanovacF.AndersonE. D.Radical cyberknife radiosurgery with tumor tracking: An effective treatment for inoperable small peripheral stage I non-small cell lung cancer. J Hematol Oncol2, 1 (2009).
14.
PennathurA.LuketichJ. D.HeronD. E.SchuchertM. J.BurtonS.AbbasG.GoodingW. E.FersonP. F.OzhasogluC.GilbertS.LandreneauR. J.ChristieN. A.Stereotactic radiosurgery for the treatment of lung neoplasm: Experience in 100 consecutive patients. The Annals of Thoracic Surgery88, 1594–1600; discussion 1600 (2009).
15.
van der Voort van ZypN. C.PrévostJ.-B.HoogemanM. S.PraagJ.van der HoltB.LevendagP. C.van KlaverenR. J.PattynamaP.NuyttensJ. J.Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: Clinical outcome. Radiother Oncol91, 296–300 (2009).
16.
DingC.ChangC.-H.HaslamJ.TimmermanR.SolbergT.A dosimetric comparison of stereotactic body radiation therapy techniques for lung cancer: Robotic versus conventional linac-based systems. J App Clin Med Phys11, 3223 (2010).
17.
SharmaS. C.OttJ. T.WilliamsJ. B.DickowD.Clinical implications of adopting Monte Carlo treatment planning for CyberKnife. J App Clin Med Phys11, 3142 (2010).
18.
WilcoxE. E.DaskalovG. M.LincolnH.ShumwayR. C.KaplanB. M.ColasantoJ. M.Comparison of planned dose distributions calculated by Monte Carlo and Ray-Trace algorithms for the treatment of lung tumors with cyberknife: A preliminary study in 33 patients. Int J Radiat Oncol Biol Phys77, 277–284 (2010).
19.
van der Voort van ZypN. C.HoogemanM. S.van de WaterS.LevendagP. C.van der HoltB.HeijmenB. J. M.NuyttensJ. J.Clinical introduction of Monte Carlo treatment planning: A different prescription dose for non-small cell lung cancer according to tumor location and size. Radiother Oncol96, 55–60 (2010).
20.
SchweikardA.GlosserG.BodduluriM.MurphyM. J.AdlerJ. R.Robotic motion compensation for respiratory movement during radiosurgery. Comput Aided Surg5, 263–277 (2000).
21.
SchweikardA.ShiomiH.AdlerJ.Respiration tracking in radiosurgery. Medi phy31, 2738–2741 (2004).
22.
HoogemanM.PrévostJ.-B.NuyttensJ.PöllJ.LevendagP.HeijmenB.Clinical accuracy of the respiratory tumor tracking system of the cyberknife: Assessment by analysis of log files. Int J Radiat Oncol Biol Phys74, 297–303 (2009).
23.
TimmermanR.PaulusR.GalvinJ.MichalskiJ.StraubeW.BradleyJ.FakirisA.BezjakA.VideticG.JohnstoneD.FowlerJ.GoreE.ChoyH.Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer. JAMA303, 1070–1076 (2010).
24.
WhyteR. I.CrownoverR.MurphyM. J.MartinD. P.RiceT. W.DecampM. M.RodebaughR.WeinhousM. S.LeQ.-T.Stereotactic radiosurgery for lung tumors: Preliminary report of a phase I trial. Ann Thorac Surg75, 1097–1101 (2003).
25.
NuyttensJ. J.PrévostJ.-B.PraagJ.HoogemanM.Van KlaverenR. J.LevendagP. C.PattynamaP. M. T.Lung tumor tracking during stereotactic radiotherapy treatment with the Cyber Knife: Marker placement and early results. Acta Oncol45, 961–965 (2006).
26.
BrownW. T.WuX.AmendolaB.PermanM.HanH.FayadF.GarciaS.LewinA.AbitbolA.de la ZerdaA.SchwadeJ. G.Treatment of early non-small cell lung cancer, stage IA, by image-guided robotic stereotactic radioablation-CyberKnife. Cancer J13, 87–94 (2007).
27.
BrownW. T.WuX.FayadF.FowlerJ. F.AmendolaB. E.GarcíaS.HanH.de la ZerdaA.BossartE.HuangZ.SchwadeJ. G.CyberKnife radiosurgery for stage I lung cancer: Results at 36 months. Clin Lung Cancer8, 488–492 (2007).
28.
BrownW. T.WuX.WenB. C.FowlerJ. F.FayadF.AmendolaB. E.GarciaS.De La ZerdaA.HuangZ.SchwadeJ. G.Early results of CyberKnife image-guided robotic stereotactic radiosurgery for treatment of lung tumors. Comput Aided Surg12, 253–261 (2007).
29.
CollinsB. T.EricksonK.ReichnerC. A.CollinsS. P.GagnonG. J.DieterichS.McRaeD. A.ZhangY.YousefiS.LevyE.ChangT.Jamis-DowC.BanovacF.AndersonE. D.Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors. Radiat Oncol2, 39 (2007).
30.
MuacevicA.DrexlerC.WowraB.SchweikardA.SchlaeferA.HoffmannR. T.WilkowskiR.WinterH.ReiserM.Technical description, phantom accuracy, and clinical feasibility for single-session lung radiosurgery using robotic image-guided real-time respiratory tumor tracking. Technol Cancer Res Treat6, 321–328 (2007).
31.
PennathurA.LuketichJ. D.BurtonS.AbbasG.HeronD. E.FernandoH. C.GoodingW. E.OzhasogluC.IrelandJ.LandreneauR. J.ChristieN. A.Stereotactic radiosurgery for the treatment of lung neoplasm: Initial experience. The Annals of Thoracic Surgery83, 1820–1824; discussion 1824–1825 (2007).
32.
BrownW. T.WuX.FowlerJ. F.GarcíaS.FayadF.AmendolaB. E.de la ZerdaA.SchwadeJ. G.Lung metastases treated by CyberKnife image-guided robotic stereotactic radiosurgery at 41 months. South Med J101, 376–382 (2008).
33.
CoonD.GokhaleA. S.BurtonS. A.HeronD. E.OzhasogluC.ChristieN.Fractionated stereotactic body radiation therapy in the treatment of primary, recurrent, and metastatic lung tumors: The role of positron emission tomography/computed tomography-based treatment planning. Clin Lung Cancer9, 217–221 (2008).
34.
AhnS. H.HanM. S.YoonJ. H.JeonS. Y.KimC. H.YooH. J.LeeJ. C.Treatment of stage I non-small cell lung cancer with CyberKnife, image-guided robotic stereotactic radiosurgery. Oncol Rep21, 693–696 (2009).
35.
PennathurA.LuketichJ. D.HeronD. E.AbbasG.BurtonS.ChenM.GoodingW. E.OzhasogluC.LandreneauR. J.ChristieN. A.Stereotactic radiosurgery for the treatment of stage I non-small cell lung cancer in high-risk patients. The Journal of Thoracic and Cardiovascular Surgery137, 597–604 (2009).
36.
BrownJ. M.DiehnM.LooB. W.Stereotactic ablative radiotherapy should be combined with a hypoxic cell radiosensitizer. Int J Radiat Oncol Biol Phys78, 323–327 (2010).
37.
VahdatS.OermannE. K.CollinsS. P.YuX.AbedalthagafiM.DebritoP.SuyS.YousefiS.GutierrezC. J.ChangT.BanovacF.AndersonE. D.EspositoG.CollinsB. T.CyberKnife radiosurgery for inoperable stage IA non-small cell lung cancer: 18F-fluorodeoxyglucose positron emission tomography/computed tomography serial tumor response assessment. J Hematol Oncol3, 6 (2010).
38.
van der Voort van ZypN. C.PrévostJ.-B.van der HoltB.BraatC.van KlaverenR. J.PattynamaP. M.LevendagP. C.NuyttensJ. J.Quality of life after stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys77, 31–37 (2010).
39.
van der Voort van ZypN. C.van der HoltB.van KlaverenR. J.PattynamaP.MaatA.NuyttensJ. J.Stereotactic body radiotherapy using real-time tumor tracking in octogenarians with non-small cell lung cancer. Lung Cancer69, 296–301 (2010).
40.
ChangC. N.ZhouL. Y.MacFarlaneG.TranP.RaoA.ChapmanC.LeQ. T.WakeleeH.ColevasA. D.WhyteR.HristovD.DieterichS.MaximP.LooB. W.Excellent early local control with tumor volume adapted dosing of stereotactic body radiation therapy for pulmonary tumors. Journal of Thoracic Oncology4, S938–S939 (2009).
41.
ClinicalTrials.gov. International Randomized Study to Compare CyberKnife Stereotactic Radiotherapy With Surgical Resection In Stage I Non-Small Cell Lung Cancer (STARS), <http://clinicaltrials.gov/show/NCT00840749> (Accessed August 5, 2010).
