Case Studies
CASE STUDY 1
Lung Cancer
06/15/07
Patient History
G. M. is a 68 year old with a history of adenocarcinoma of the left lower lobe of the lung, and a similar tumor in the right lower lobe of the lung, both treated surgically in 1999 and one year ago, respectively. He then received postoperative chemotherapy until December when he presented with a PET positive 2.5 cm. nodule in the right lower lobe. G.M. refused further surgery and contacted the CyberKnife Center of Miami for treatment alternatives.
CyberKnife Advantage
Recent scientific data suggests that stereotactic radiosurgery with devices such as the CyberKnife can deliver ablative doses of irradiation, potentially resulting in treatment outcomes similar to surgery. This approach is indicated for the medically inoperable or patient who refuses surgery for early stage carcinoma of the lung.
Treatment
The patient was treated on the CyberKnife with a breathold technique. Stereotactic irradiation was delivered to the periphery of the tumor using two fractions to a total dose of 4000 cGy.
Follow-up
At two weeks post treatment, the patient experienced moderate esophagitis, lasting two weeks. At three months post treatment, the PET scan showed no hypermetabolic activity within the treated field or elsewhere. Clinically, the patient is well with no complaints.
Miami CyberKnife Team:
Thoracic Surgeon: William T. Brown, MD
Radiation Oncologist: Mark Perman, MD
Medical Physicist: Xiaodong Wu, PhD
Radiation Therapist: Margarita Asmar, RTT
CASE STUDY 2
Recurrent Head and Neck Cancer
06/15/07
Patient History
This is a 68 year-old white female who presented with recurrent squamous cell carcinoma of the oral cavity with node recurrence,status post modified neck dissection. She presented with a large recurrent mass in the parapharyngeal region treated with hyperfractionated radiotherapy and multiple surgical procedures. She had a large skull base parapharyngeal mass for plan boost radiosurgery.
CyberKnife Advantage
Because of both the prior history of multiple surgeries and the close proximity of this tumor to the skull base, major blood vessels and brain stem, surgical resection was not a possible option.
Treatment
The patient was treated on the frameless CyberKnife at Miami CyberKnife with 3 fraction of 7 Gy each with a total dose of 21 Gy plus the external radiation therapy.
Outpatient and Follow-Up
She is 4 months post treatment with good local control and gaining weight.
CyberKnife Team
Oral/Maxillary Surgeon: Mark Stevens, DMD
Radiation Oncologist: Beatriz E. Amendola, MD
Medical Physicist: Xiaodong Wu, PhD
Radiation Therapist: Maragarita Asmar, RTT
CASE STUDY 3
Cost-Effectiveness Analysis of Stereotactic Body Radiotherapy and Radiofrequency Ablation for Medically Inoperable, Early-Stage Non-Small Cell Lung Cancer
03/07/11
DAVID J. SHER, M.D., M.P.H. | JON O. WEE, M.D. | RINAA S. PUNGLIA, M.D., M.P.H.
*Department of Radiation Oncology and zCenter for Outcomes and Policy Research, and xThoracic Surgery, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA
Purpose: The standard management of medically inoperable Stage I non–small-cell lung cancer (NSCLC) conventionally has been fractionated three-dimensional conformal radiation therapy (3D-CRT). The relatively poor local control rate and inconvenience associated with this therapy have prompted the development of stereotactic body radiotherapy (SBRT), a technique that delivers very high doses of irradiation typically over 3 to 5 sessions. Radiofrequency ablation (RFA) has also been investigated as a less costly, single-day therapy that thermally ablates small, peripheral tumors. The cost-effectiveness of these three techniques has never been compared.
Methods and Materials: We developed a Markov model to describe health states of 65-year-old men with medically inoperable NSCLC after treatment with 3D-CRT, SBRT, and RFA. Given their frail state, patients were assumed to receive supportive care after recurrence. Utility values, recurrence risks, and costs were adapted from the literature. Sensitivity analyses were performed to model uncertainty in these parameters.
Results: The incremental cost-effectiveness ratio for SBRTover 3D-CRTwas $6,000/quality-adjusted life-year, and the incremental cost-effectiveness ratio for SBRTover RFAwas $14,100/quality-adjusted life-year. One-way sensitivity analysis showed that the results were robust across a range of tumor sizes, patient utility values, and costs. This result was confirmed with probabilistic sensitivity analyses that varied local control rates and utilities.
Conclusion: In comparison to 3D-CRT and RFA, SBRT was the most cost-effective treatment for medically inoperable NSCLC over a wide range of treatment and disease assumptions. On the basis of efficacy and cost, SBRT should be the primary treatment approach for this disease. 2011 Elsevier Inc. Stereotactic radiation therapy, Inoperable lung cancer, Cost-effectiveness analysis.
*To view the complete study, Click here
