Patients with cancer often suffered from spinal metastasis, and spinal cord compression from spinal metastasis represents a substantial clinical problem. External beam radiotherapy (EBRT) or conventional surgical decompression of the spinal cord often results in unsatisfactory neurological recovery and local recurrence. To improve neurological recovery and local control in such cases, we introduced intraoperative radiotherapy (IORT) combined with posterior surgery in 1992. We report the results for neurological recovery and local control in patients who received IORT combined with posterior surgery. Between November 1992 and March 2009, 158 cases (133 patients) were treated using IORT combined with posterior surgery for spinal paresis due to spinal metastases of breast, renal, thyroid, colorectal, and lung cancer. 99 cases were nonambulatory and 59 cases ambulatory before surgery. After posterior decompression, a single large dose of electron beam irradiation was delivered to the exposed metastatic lesion. Percentage dose in the spinal cord was approximately 10 - 25% with a lead shield, however, scattering of electron beams spread from behind the shielded central spinal cord region to reach the posterior region of the vertebra body located directly anterior to the spinal cord. Median dose of IORT was 20 Gy (range, 10 - 35 Gy), and median energy was 16 MeV (range, 11 - 22 MeV). 61 cases were treated with EBRT before the surgery; the delivered median dose was 40 Gy (range, 7.5 - 60 Gy). 41 cases were treated with EBRT after the surgery; the delivered median dose was 35 Gy (range, 8 - 50.5 Gy). Neurologic improvement of at least one level according to Frankel's classification was attained in 106 cases (67%) with a median follow-up period of 12.8 months. Spinal paralysis completely disappeared after surgery in 34 cases (22%). Of all 158 cases, 136 cases (86%) were ambulatory after surgery. Of the 99 cases nonambulatory before surgery, 78 cases (80%) became ambulatory after surgery. Postoperatively, 14 cases (9%) experienced local recurrence and neurologic exacerbation of at least one level according to Frankel's classification. The median time to local recurrence was 10.6 months (range, 3.0 - 40.6 months) after the surgery. For all 158 cases, median survival time was 18.5 months (range, 0.5 - 111.8 months) after the surgery. One patient experienced radiation myelopathy, and another patient experienced radiation neuropathy of cauda equina during the follow-up period. IORT combined with posterior surgery is a useful technique for the treatment of spinal cord compression caused by spinal metastasis, offering significant neurologic recovery and a low rate of local recurrence.

Three-dimensional non-coplanar conformal radiotherapy (3-DNCCRT) has recently been considered promising for the treatment of stage I non-small cell lung cancer (NSCLC). Usually, it is performed in the form of SBRT using 10 - 20Gy fraction dose. However, this method is considered to be contraindicated for so-called central tumors because of the toxicity of serial organs, such as bronchus, great vessels, etc. We have been treating these tumors with relatively small fraction dose (usually 3Gy) keeping BED10 at the similar level to that of SBRT. In this study, we compared the results of central tumors and peripheral tumors to see if the results of the central tumors are comparable with those of peripheral tumors. Eligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation regarding age and pulmonary function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams to a total dose of 75Gy in 25 fractions in 5 weeks. Irradiation was aiming at the internal target volume with proper margins. No elective nodal irradiation was given. Between January 2002 and November 2008, 80 eligible cases were treated. Age ranged from 53 to 91 (median 77). The male/female ratio was 59/21. There were 48 T1 tumors and 32 T2. Fifteen tumors were SQCCA, 56 adenoca, 2 large cell ca and 7 NSCLC NOS. There were 66 inoperable cases (83%), among them poor pulmonary function was in 48 (60%), and 14 operable cases, who refused operation. The average tumor size was 3.0 cm (range: 1.0 to 5.0 cm). There were 75 PS 1 and 5 PS 2 cases. Among the entire cases, 37 cases were central tumors and the other 43 were peripheral tumors. There were no differences in the patient characteristics between central and peripheral tumors. Median follow-up period was 37 months. Three-year local control rate, overall survival rate, cause-specific survival rate, and relapse-free survival rate for overall cases were, 86%, 66%, 78%, and 59%, respectively. For central tumors, they were, 85%, 68%, 79%, and 55%, respectively, and for peripheral tumors, they were, 86%, 64%, 77%, and 61%, respectively. There were no differences between the two groups. There were 7 Grade 3 pulmonary toxicities (9%, 3 in central, 4 in peripheral, n.s.), but there were no severe adverse effects concerning serial organs in either group. The 3-DNCCRT for stage I non-small cell lung cancer has been safe and effective both for central and peripheral tumors, and might become an alternative treatment for central tumors, which SBRT might cause serious toxicities. Further follow-up with a larger number of cases were necessary.

For solitary non-small cell lung cancers (NSCLC), we have been using 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) with middle-sized fractions with a fairly good treatment results. Maximum uptake value of FDG has been reported to correlate with the activity of the tumor, and thus with the prognosis of the tumor. We investigated whether the prognosis of our cases were correlated with the SUV-max of FDG-PET scan prior to the conformal radiotherapy. Sixty-two cases with pretreatment FDG-PET scan treated between January 2004 and March 2009 were analyzed. We delivered 75Gy in 25 fractions for all tumors. There were 43 male cases and 19 female cases. There were 14 operable cases and 48 inoperable cases. The age ranged from 53 to 91 with a median age of 77. Histologically, there were 36 adenocarcinomas, 20 squamous cell carcinomas, and 6 cases of NSCLC not otherwise specified (NOS). By T-stage, there were 37 T1 cases, 25 T2 cases. SUV-max ranged from 0 to 32.2 with a median of 7.5. The median follow-up period was 22 months. There were 7 local recurrences and 13 total recurrences. Overall survival rate at 2 years was 88.8%. Overall relapse-free survival rate at 2 years was 71.2%. Overall local control rate at 2 years was 86.4%. By T-stage, 2-year relapse-free survival rates were 60.0% for T1 cases, and 86.3% for T2 cases (n.s.). By histology, 2-year relapse-free survival rates were 75.8% for adenocarcinoma, 66.7% for squamous cell carcinoma, and 53.3% for NSCLC (n.s.). By operable cases, 2-year relapse-free survival rates were 81.5% for operable and 67.8% for inoperable (n.s.). By SUV-max, 2-year relapse-free survival rates were 95.2% for cases whose SUV-max is less than 5, and 57.0% for cases not less than 5 (p = 0.007). Overall survival rates were 100% for the former and 81.7% for the latter at 2 years (n.s.). There was no local recurrence for former. High SUV-max is associated with worse prognosis for solitary NSCLC treated by 3DNCCRT, whereas low SUV-max is associated with very good prognosis. Care should be taken to avoid the recurrence for high SUV-max tumors. Further studies with larger number of the cases are necessary.

Purpose/Objective(s)Non-coplanar conformal radiotherapy has recently been considered promising for the treatment of Stage I non–small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20 Gy. However, this treatment method has contraindications for so-called central tumors because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3 ∼ 4 Gy) without fixation for almost 10 years. The tolerance dose of the critical organs might be increased and tumors located nearby could be treated safely. Formerly, we presented our preliminary data at this meeting. This year we will report our updated results with longer follow-up period and larger number of cases.Materials/MethodsEligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation regarding age and pulmonary function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation was aiming at the internal target volume with proper margins. No elective nodal irradiation was given. Between Sep. 1999 and Feb. 2008, 90 eligible cases were treated. Age ranged from 39 to 91 (median 77). The male/female ratio was 62/28. There were 52 T1 tumors and 38 T2. Twenty tumors were squamous cell carcinoma, 60 adenoca, and 10 others. There were 77 inoperable cases (86%), among which poor pulmonary function was in 54, and 13 operable cases, who refused operation. The average tumor size was 3.0cm (range; 1.0 to 5.0 cm). There were 2 PS0, 81 PS 1 and 7 PS 2 cases. Median total radiation dose was 75 Gy (range, 59.5–76.5 Gy). Median overall treatment time was 35 days. Median follow-up period was 32 months.ResultsOverall 1-, 3-, and 5-year survival rates (SR) were 96%, 71%, and 53%, respectively. Local control rates (LCR) at 1, 3, and 5 years were 99%, 86%, 82%, respectively. Cause-specific SR at 1, 3, and 5 years were 100%, 82%, 68%, respectively. Relapse-free SR at 1, 3, and 5 years were 91%, 58%, 40%, respectively. As for Stage, 3-year overall SR and LCR were 67% and 86% for T1 cases, and 77% and 87% for T2 cases (n.s.). Twenty-eight patients developed recurrence; 11 in local, 5 in mediastinal, 3 in pleura and 9 in distant organs. Twenty-eight cases have died. Among them 16 died of the disease, 7 died of intercurrent diseases, and the other 5 died of pneumonia. Six cases (7%) developed Grade 3 or higher pulmonary complications, all of whom had had pulmonary comorbidities. No severe complications regarding serial organs have been observed.ConclusionsConsidering the status of our patients, our method might be promising with favorable survival and local control results even in T2 cases with acceptable toxicity, and not worse compared with the published results of SBRT for the treatment of Stage I NSCLC. Purpose/Objective(s)Non-coplanar conformal radiotherapy has recently been considered promising for the treatment of Stage I non–small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20 Gy. However, this treatment method has contraindications for so-called central tumors because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3 ∼ 4 Gy) without fixation for almost 10 years. The tolerance dose of the critical organs might be increased and tumors located nearby could be treated safely. Formerly, we presented our preliminary data at this meeting. This year we will report our updated results with longer follow-up period and larger number of cases. Non-coplanar conformal radiotherapy has recently been considered promising for the treatment of Stage I non–small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20 Gy. However, this treatment method has contraindications for so-called central tumors because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3 ∼ 4 Gy) without fixation for almost 10 years. The tolerance dose of the critical organs might be increased and tumors located nearby could be treated safely. Formerly, we presented our preliminary data at this meeting. This year we will report our updated results with longer follow-up period and larger number of cases. Materials/MethodsEligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation regarding age and pulmonary function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation was aiming at the internal target volume with proper margins. No elective nodal irradiation was given. Between Sep. 1999 and Feb. 2008, 90 eligible cases were treated. Age ranged from 39 to 91 (median 77). The male/female ratio was 62/28. There were 52 T1 tumors and 38 T2. Twenty tumors were squamous cell carcinoma, 60 adenoca, and 10 others. There were 77 inoperable cases (86%), among which poor pulmonary function was in 54, and 13 operable cases, who refused operation. The average tumor size was 3.0cm (range; 1.0 to 5.0 cm). There were 2 PS0, 81 PS 1 and 7 PS 2 cases. Median total radiation dose was 75 Gy (range, 59.5–76.5 Gy). Median overall treatment time was 35 days. Median follow-up period was 32 months. Eligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation regarding age and pulmonary function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation was aiming at the internal target volume with proper margins. No elective nodal irradiation was given. Between Sep. 1999 and Feb. 2008, 90 eligible cases were treated. Age ranged from 39 to 91 (median 77). The male/female ratio was 62/28. There were 52 T1 tumors and 38 T2. Twenty tumors were squamous cell carcinoma, 60 adenoca, and 10 others. There were 77 inoperable cases (86%), among which poor pulmonary function was in 54, and 13 operable cases, who refused operation. The average tumor size was 3.0cm (range; 1.0 to 5.0 cm). There were 2 PS0, 81 PS 1 and 7 PS 2 cases. Median total radiation dose was 75 Gy (range, 59.5–76.5 Gy). Median overall treatment time was 35 days. Median follow-up period was 32 months. ResultsOverall 1-, 3-, and 5-year survival rates (SR) were 96%, 71%, and 53%, respectively. Local control rates (LCR) at 1, 3, and 5 years were 99%, 86%, 82%, respectively. Cause-specific SR at 1, 3, and 5 years were 100%, 82%, 68%, respectively. Relapse-free SR at 1, 3, and 5 years were 91%, 58%, 40%, respectively. As for Stage, 3-year overall SR and LCR were 67% and 86% for T1 cases, and 77% and 87% for T2 cases (n.s.). Twenty-eight patients developed recurrence; 11 in local, 5 in mediastinal, 3 in pleura and 9 in distant organs. Twenty-eight cases have died. Among them 16 died of the disease, 7 died of intercurrent diseases, and the other 5 died of pneumonia. Six cases (7%) developed Grade 3 or higher pulmonary complications, all of whom had had pulmonary comorbidities. No severe complications regarding serial organs have been observed. Overall 1-, 3-, and 5-year survival rates (SR) were 96%, 71%, and 53%, respectively. Local control rates (LCR) at 1, 3, and 5 years were 99%, 86%, 82%, respectively. Cause-specific SR at 1, 3, and 5 years were 100%, 82%, 68%, respectively. Relapse-free SR at 1, 3, and 5 years were 91%, 58%, 40%, respectively. As for Stage, 3-year overall SR and LCR were 67% and 86% for T1 cases, and 77% and 87% for T2 cases (n.s.). Twenty-eight patients developed recurrence; 11 in local, 5 in mediastinal, 3 in pleura and 9 in distant organs. Twenty-eight cases have died. Among them 16 died of the disease, 7 died of intercurrent diseases, and the other 5 died of pneumonia. Six cases (7%) developed Grade 3 or higher pulmonary complications, all of whom had had pulmonary comorbidities. No severe complications regarding serial organs have been observed. ConclusionsConsidering the status of our patients, our method might be promising with favorable survival and local control results even in T2 cases with acceptable toxicity, and not worse compared with the published results of SBRT for the treatment of Stage I NSCLC. Considering the status of our patients, our method might be promising with favorable survival and local control results even in T2 cases with acceptable toxicity, and not worse compared with the published results of SBRT for the treatment of Stage I NSCLC.

Purpose/Objective(s)As the prognosis of lung cancer patients improves, more metachronous multiple primary lung cancers occur. Surgery has been considered to be the treatment of choice. However, there are many medically inoperable cases among them and conformal radiotherapy might provide safe and effective treatment results though there have been very scarce reports. We have been using 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) for solitary lung tumors using middle-sized fraction dose (3–4 Gy). The treatment results of the second or third metachronous non–small cell lung cancer (NSCLC) following the resection of initial primary cancer were analyzed.Materials/MethodsEligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation concerning age and respiratory function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation was aiming at the ITV with proper margins. No ENI was performed. Twenty-one patients treated with this method between Jun. 2004 and Jan. 2008 were reviewed. Patient characteristics were as follows; Age ranged from 39 to 90 (median 76). Male/female ratio was 14/7. There were 14 T1 tumors and 7 T2. Histologically, adeno/squamous/unknown (GGO) was 15/3/3. As for PS, PS 0/1/2 was 1/19/1. Concerning respiratory functions, %VC ranged from 57 to 107% (median 85%), FEV1.0 ranged from 0.51 to 2.42L (median 1.39L). Concerning the initial operation, 19 cases underwent lobectomy and 2 cases did partial resection. The interval between the initial operation and this therapy ranged from 6 months to 16 years (median 45 months). Total dose ranged from 60 to 75 Gy (median 75 Gy), median OTT was 35 days, and median FOLLOW-UP period was 22 months.ResultsOverall survival rates (SR) at 2 and 4 years were 95% and 76%. Local control rates (LCR) at 2 and 4 years were 88% and 88%. Cause specific SR at 2 and 4 years were 100% and 80%. Relapse-free SR at 2 and 4 years were 75% and 75%. There was no difference in SR or LCR by the size of the tumor. The interval between the two treatments did not affect the prognosis. Four patients recurred. Among them 2 were local and 2 were regional LN. One patient died of lung cancer and one patient who had had interstitial pneumonitis died of radiation pneumonitis. No fatal complications were observed for other organs.ConclusionsAlthough follow-up period is short and the number of cases is small, our technique (3DNCCRT) for metachronous multiple primary NSCLC following the resection of initial lesion was promising with good survival and local control results with acceptable toxicities. Conformal radiation therapy might be an alternative to surgery for these tumors which will increase in number in near future. Further study is necessary. Purpose/Objective(s)As the prognosis of lung cancer patients improves, more metachronous multiple primary lung cancers occur. Surgery has been considered to be the treatment of choice. However, there are many medically inoperable cases among them and conformal radiotherapy might provide safe and effective treatment results though there have been very scarce reports. We have been using 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) for solitary lung tumors using middle-sized fraction dose (3–4 Gy). The treatment results of the second or third metachronous non–small cell lung cancer (NSCLC) following the resection of initial primary cancer were analyzed. As the prognosis of lung cancer patients improves, more metachronous multiple primary lung cancers occur. Surgery has been considered to be the treatment of choice. However, there are many medically inoperable cases among them and conformal radiotherapy might provide safe and effective treatment results though there have been very scarce reports. We have been using 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) for solitary lung tumors using middle-sized fraction dose (3–4 Gy). The treatment results of the second or third metachronous non–small cell lung cancer (NSCLC) following the resection of initial primary cancer were analyzed. Materials/MethodsEligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation concerning age and respiratory function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation was aiming at the ITV with proper margins. No ENI was performed. Twenty-one patients treated with this method between Jun. 2004 and Jan. 2008 were reviewed. Patient characteristics were as follows; Age ranged from 39 to 90 (median 76). Male/female ratio was 14/7. There were 14 T1 tumors and 7 T2. Histologically, adeno/squamous/unknown (GGO) was 15/3/3. As for PS, PS 0/1/2 was 1/19/1. Concerning respiratory functions, %VC ranged from 57 to 107% (median 85%), FEV1.0 ranged from 0.51 to 2.42L (median 1.39L). Concerning the initial operation, 19 cases underwent lobectomy and 2 cases did partial resection. The interval between the initial operation and this therapy ranged from 6 months to 16 years (median 45 months). Total dose ranged from 60 to 75 Gy (median 75 Gy), median OTT was 35 days, and median FOLLOW-UP period was 22 months. Eligibility criteria were as follows: maximum tumor diameter not greater than 5cm, PS between 0 and 2, and no limitation concerning age and respiratory function. Radiotherapy was given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation was aiming at the ITV with proper margins. No ENI was performed. Twenty-one patients treated with this method between Jun. 2004 and Jan. 2008 were reviewed. Patient characteristics were as follows; Age ranged from 39 to 90 (median 76). Male/female ratio was 14/7. There were 14 T1 tumors and 7 T2. Histologically, adeno/squamous/unknown (GGO) was 15/3/3. As for PS, PS 0/1/2 was 1/19/1. Concerning respiratory functions, %VC ranged from 57 to 107% (median 85%), FEV1.0 ranged from 0.51 to 2.42L (median 1.39L). Concerning the initial operation, 19 cases underwent lobectomy and 2 cases did partial resection. The interval between the initial operation and this therapy ranged from 6 months to 16 years (median 45 months). Total dose ranged from 60 to 75 Gy (median 75 Gy), median OTT was 35 days, and median FOLLOW-UP period was 22 months. ResultsOverall survival rates (SR) at 2 and 4 years were 95% and 76%. Local control rates (LCR) at 2 and 4 years were 88% and 88%. Cause specific SR at 2 and 4 years were 100% and 80%. Relapse-free SR at 2 and 4 years were 75% and 75%. There was no difference in SR or LCR by the size of the tumor. The interval between the two treatments did not affect the prognosis. Four patients recurred. Among them 2 were local and 2 were regional LN. One patient died of lung cancer and one patient who had had interstitial pneumonitis died of radiation pneumonitis. No fatal complications were observed for other organs. Overall survival rates (SR) at 2 and 4 years were 95% and 76%. Local control rates (LCR) at 2 and 4 years were 88% and 88%. Cause specific SR at 2 and 4 years were 100% and 80%. Relapse-free SR at 2 and 4 years were 75% and 75%. There was no difference in SR or LCR by the size of the tumor. The interval between the two treatments did not affect the prognosis. Four patients recurred. Among them 2 were local and 2 were regional LN. One patient died of lung cancer and one patient who had had interstitial pneumonitis died of radiation pneumonitis. No fatal complications were observed for other organs. ConclusionsAlthough follow-up period is short and the number of cases is small, our technique (3DNCCRT) for metachronous multiple primary NSCLC following the resection of initial lesion was promising with good survival and local control results with acceptable toxicities. Conformal radiation therapy might be an alternative to surgery for these tumors which will increase in number in near future. Further study is necessary. Although follow-up period is short and the number of cases is small, our technique (3DNCCRT) for metachronous multiple primary NSCLC following the resection of initial lesion was promising with good survival and local control results with acceptable toxicities. Conformal radiation therapy might be an alternative to surgery for these tumors which will increase in number in near future. Further study is necessary.

For solitary non-small-cell lung cancers (NSCLC), we have been using 3-dimensional non-coplanar conformal techniques such as stereotactic body radiotherapy (SBRT) or 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) with middle-sized fractions with a fairly good treatment results. FDG-PET scan has been considered useful in the staging of such cases. Maximum uptake value of FDG has been reported to correlate with the activity of the tumor, and thus with the prognosis of the tumor. We investigated whether the prognosis of our cases were correlated with the SUV-max of FDG-PET scan prior to the conformal radiotherapy. Sixty-nine cases with pretreatment PET scan treated between August 2003 and March 2007 were analyzed. There were 47 male cases and 22 female cases. The age ranged from 50 to 91 with an average of 75. Histologically, there were 46 adenocarcinomas, 11 squamous cell carcinomas, and 12 cases of NSCLC not otherwise specified (NOS). By T-stage, there were 41 T1 cases, 26 T2 cases, 1 T3 and T4 case each. SUV-max ranged from 1 to 22.7 with an average of 7.4. Median follow-up period for alive cases was 25 months. There were 24 SBRT cases, whose treatment schedule was 48 Gy in 4 fractions in 1 week, and 45 3DNCCRT cases whose median total dose was 75 Gy in 5 weeks. In both techniques, no elective nodal irradiation was given. There were 9 local recurrences, 6 distant metastases, 5 regional lymph node metastases, and 1 pleural dissemination. The remaining 48 cases (70%) were controlled. Overall local control rates at 2 and 4 years were 84% and 84%, respectively. Overall survival rates at 2 and 4 years were 84% and 81%, respectively. Overall relapse-free survival rates at 2 and 4 years were 65% and 59%, respectively. By treatment method, 2-year relapse-free survival rates were 74% for SBRT cases, and 60% for 3DNCCRT cases (n.s.). By T-stage, 2-year relapse-free survival rates were 65% for T1 cases, and 67% for T2+ cases (n.s.). By histology, 2-year relapse-free survival rates were 64% for squamous cell carcinoma, 67% for adenocarcinoma, and 62% for NOS (n.s.). By SUV-max, 2-year relapse-free survival rates were 83% for cases whose SUV-max is less than 5, and 53% for cases not less than 5 (p < 0.025). Overall survival was also significantly different: 93% for the former and 77% for the latter at 2 years (p < 0.04). High SUV-max carries worse prognosis for solitary NSCLC treated by SBRT or 3DNCCRT. Care should be taken to avoid the recurrence for such tumors. Further studies with larger number of the cases are necessary.

Non-coplanar conformal radiotherapy has recently been considered promising for the treatment of stage I non-small cell lung cancer (NSCLC). Usually, it is performed with some kind of fixation or gating and with relatively high fraction doses of 10 to 20 Gy. However, this treatment method has contraindications for so-called centrally located tumors because of its high fraction dose. We have been treating these tumors with relatively low fraction dose (3∼4 Gy) without fixation. The tolerance dose of the critical organs might be increased and tumors located nearby could be treated safely. Furthermore, as our method does not need fixation nor breath-holding, it can be widely applied for elderly or compromised patients. Formerly, we presented our preliminary data at this meeting. This year we will report our updated results with longer follow-up period and larger number of cases. Eligibility criteria were as follows: maximum tumor diameter not greater than 5 cm, PS between 0 and 2, and no limitation concerning age and respiratory function. Radiotherapy is given with 6MV photon beam by fixed 10 non-coplanar conformal beams. Irradiation is aiming at the internal target volume with proper margins. No elective nodal irradiation is performed. Between September 1999 and March 2006, 64 eligible patients were treated with this method. Age ranged from 53 to 91 (average 76). The male/female ratio was 44/20. There were 37 patients with T1 tumors and 27 patients with T2 tumors. Fourteen tumors were sqcca, 44 were adenoca, 1 was large cell ca and 5 were NSCLC NOS. There were 55 inoperable patients (86%) the reasons for which were pulmonary in 34 patients, old age in 8, cardiac in 5 and so on. Remaining 9 patients were operable but refused operation. The average size of the tumor was 3.1 cm (range; 1.0 to 5.0 cm). As for PS, there were 59 PS 1 and 5 PS 2 patient. Total radiation dose ranged from 59.5 Gy to 76.5 Gy with a median of 75 Gy. Overall treatment time ranged from 26 to 42 days (median 35 days). Median follow-up period was 28 months (range: 12∼88 months). Average V20 of the normal lung was 11.5% (range; 2%–21%). Overall 1-, 3-, and 5-year survival rates (SR) were 94%, 74%, and 62%, respectively. Local control rates (LCR) at 1, 3, and 5 years were 98%, 85%, 76%, respectively. Cause-specific survival rates at 1, 3, and 5 years were 100%, 85%, 71%, respectively. Relapse-free survival rates at 1, 3, and 5 years were 91%, 58%, 47%, respectively. There was no difference in SR nor LCR between T1 and T2 tumors. Seventeen patients developed recurrence; 7 in local, 3 in mediastinal, 2 in pleura and 5 in distant organs. Fourteen patients have died. Among them 7 patients died of the disease, 1 died of other cancer, 3 died of intercurrent diseases, and the other 3 died of pneumonia. Five patients (8%) developed grade 3 or higher pulmonary complications according to NCI-CTCAEv3.0, all of whom had had pulmonary comorbidities. No life-threatening complications regarding heart, large vessels, esophagus, spinal cord, etc. have been observed. Considering the status of our patients, our method might be promising with favorable survival and local control results and with acceptable toxicity, and not worse compared with the published results of SBRT for the treatment of stage I NSCLC and might have broader indications. Longer follow-up with larger number of patients is still necessary.

20515 Background: Metastatic spinal tumors often cause spinal cord compression and jeopardize the quality of life of the patients much. To decrease the local symptomatic recurrence rate, we have been adding IORT to decompression surgery. Methods: For those patients whose life expectancy was more than 6 months were eligible for this treatment. Posterior decompression by laminectomy of the involved vertebrae was performed. Following decompression, the patient was irradiated the lesions intraoperatively with electrons generated from Microtron by shielding the spinal cord with lead plate. The central aspects of the vertebrae were irradiated by scattered electrons detouring from the edge of the lead shield up to 40% of the administered dose. Following IORT, posterior instrumentation was performed. External beam radiotherapy might be added pre- and/or postoperatively when considered necessary. Results: 108 patients were treated between 1992–2005. There were 58 males and 50 females. Age ranged from 26 to 85 with a median of 62.5. By primary sites, 26 breast, 24 kidney, 18 colorectum, 17 lung 12 prostate and 11 thyroid cases were included. Irradiated spines were cervical in 6, thoracic in 76, and lumbar/sacral in 27. Overall median follow-up period was 12.7months. Median IORT dose was 20Gy (range 15–26Gy) and median electron energy was 16MeV (range 11–22MeV). There were 37 cases with preoperative RT and 41 cases with postoperative RT. Overall median survival time was 14.5months (breast 15.3, kidney 22.6, colorectum 5.7, lung 6.2, prostate 31.6, thyroid 60.6months). Neurological response rate was 73.1%. Ambulatory rates were 87.0% for success and 80.6% for rescue by Klimo's definition(2005). There were only 8 symptomatic relapses (7%). As for major complications, only one myelopathy has been observed. Conclusions: Decompression surgery and IORT for metastatic spinal tumors with impending spinal cord compression was a promising treatment modality with excellent local control and neurological response rate and with minimal toxicity especially for those patients with long-term prognosis. No significant financial relationships to disclose.

Évaluation prospective de la préservation des glandes salivaires, des survies globales et sans récidive locale après traitement de cancers ORL par tomothérapie hélicoïdale (TH).De mars 2007 à février 2009, 30 patients atteints de cancers ORL ont été traités par TH. La fraction d’excrétion salivaire (FES) a été évaluée par scintigraphie au technétium avant, 6, 12 et 18 mois après la TH, permettant de définir le taux de préservation glandulaire. Parallèlement, les patients ont été examinés tous les 3 mois pour évaluer les toxicités cliniques.Le suivi médian a été de 4,3 ans. La dose moyenne reçue aux glandes parotides homolatérales (GPH) a été de 25,4 Gy. Dix-neuf patients ont pu être évalués à 18 mois par scintigraphie, et ils ont eu une bonne préservation des GP (84 %). Parmi les 6 patients ayant reçu plus de 26 Gy dans la parotide, la survie sans récidive locale (SSRL) était de 100 % à 5 ans. La SSRL à 28 mois était de 33 % dans le groupe ayant reçu moins de 20 Gy versus 91 % dans le groupe ayant reçu plus de 20 Gy à la GPH.La tomothérapie hélicoïdale nous a permis de réduire l’incidence et la sévérité de la xérostomie. Nous avons montré qu’une dose moyenne délivrée aux parotides entre 20 et 26 Gy préservait la fonction salivaire sans compromettre l’efficacité du traitement. Par contre, la préservation parotidienne limitant la dose moyenne en dessous de 20 Gy augmente le risque de récidive locale.