Early Clinical Experience and Outcome With Helical Tomotherapy for Multiple Metastatic Lesions

I. Lee, J. Seong, IJROBP Volume 69, Issue 3, Page S573 (1 November 2007)

Yosei University College of Medicine, Seoul, Republic of Korea

The purpose of this study was to evaluate the feasibility and the problems that require attention in the treatment of helical tomotherapy for multiple metastatic lesions.

Forty two patients with multiple metastatic lesions were treated with tomotherapy from April 2006 to Feb 2007. Among the patients, 21 patients had bone metastasis, and 8 patients were re-irradiated to previously treated area. Treatment planning was performed using Tomotherapy Hi-Art System, version 2.0 (TomoTherapy, WI, USA), applying simultaneously integrated boost technique. Subjective pain response to treatment was assessed using the Wisconsin Brief Pain Questionnaire, and the morbidity was evaluated by the Common Terminology Criteria for Adverse Events v3.0.

In forty two patients, couch travel distance (Y field) ranged from 8 to 69.1 cm, and the mean treatment time was 16 minutes and 1 second (range, 3 minutes and 24 seconds–37 minutes and 24 seconds). In two patients, treatment time and fraction size were changed due to poor performance status or hematologic toxicity. For five patients with the lesions separated far longitudinally, 2 independent plans were performed so that the longitudinal ranges could be reduced with MVCT performed at each field. With regard to pain palliative effect for bone metastatic patients, there were 16 patients (76.2%) with subjective response, and 5 patients (23.8%) with no response. Among the patients, 3 patients showed grade IV neutropenia and these significantly correlated with the amount of red marrow weight (p = 0.001).

 Eight non-small cell lung cancer patients with multiple metastatic lesions were treated with tomotherapy. Among the patients, 4 patients had separate metastatic pulmonary tumor nodules in the ipsilateral or contralateral lung, 4 patients with bone metastasis, 1 patient with brain metastasis, and 1 patient with adrenal gland metastasis. Four patients with separate metastatic pulmonary nodules showed multiple hematogenous lung metastases within 2 months follow up. In lung cancer patients with exptrapulmonary metastatic lesions, only one patient recurred as hematogenous lung metastases at 8 months follow up. The toxicity profile was; the grade II toxicities with skin reaction in 1 patient, esophagitis in 2 patients, and the main grade III toxicity was leucopenia in 2 patients.

Conclusions

Helical tomotherapy was effective for symptom palliation and feasible for patients with multiple bone metastatic diseases. However, patients with separate multiple pulmonary nodules showed no benefit for tomotherapy.