Toxic risk of stereotactic body radiotherapy and concurrent helical tomotherapy followed by erlotinib for non-small-cell lung cancer treatment--case report

Chen-Hsi Hsieh, Hou-Tai Chang, Shih-Chiang Lin, Yu-Jen Chen, Li-Ying Wang, Yen-Ping Hsieh, Chien-An Chen, Ngot-Swan Chong, Shoei Long Lin, Chun-Yi Chen, Pei-Wei Shueng, Chen-Hsi Hsieh, Hou-Tai Chang, Shih-Chiang Lin, Yu-Jen Chen, Li-Ying Wang, Yen-Ping Hsieh, Chien-An Chen, Ngot-Swan Chong, Shoei Long Lin, Chun-Yi Chen, Pei-Wei Shueng

Abstract

Background: Stereotactic body radiation therapy (SBRT) applied by helical tomotherapy (HT) is feasible for lung cancer in clinical. Using SBRT concurrently with erlotinib for non-small cell lung cancer (NSCLC) is not reported previously.

Case presentation: A 77-year-old man with stage III NSCLC, received erlotinib 150 mg/day, combined with image-guided SBRT via HT. A total tumor dose of 54 Gy/9 fractions was delivered to the tumor bed. The tumor responded dramatically and the combined regimen was well tolerated. After concurrent erlotinib-SBRT, erlotinib was continued as maintenance therapy. The patient developed dyspnea three months after the combined therapy and radiation pneumonitis with interstitial lung disease was suspected.

Conclusions: Combination SBRT, HT, and erlotinib therapy provided effective anti-tumor results. Nonetheless, the potential risks of enhanced adverse effects between radiation and erlotinib should be monitored closely, especially when SBRT is part of the regimen.

Figures

Figure 1
Figure 1
Dose distribution in the first treatment course. Tomotherapy treatment planning with high conformity (conformal index, CI = 1.03). Red, green, and blue areas are 100%, 90%, and 50% of the prescribed radiation dose, respectively. The blue dots outline the lung structure and the sky-blue dots indicate the radiation target.
Figure 2
Figure 2
Dose distribution in the second treatment course. Tomotherapy treatment planning with high conformity (conformal index, CI = 1.03). Red, green, and blue areas are 100%, 90%, and 50% of the prescribed radiation dose, respectively. The blue dots outline the lung structure and the sky-blue dots indicate the radiation target.
Figure 3
Figure 3
Transverse view of upper lung field with tumor located in the right upper lung apex. Chest computed tomography (CT) done post intubation shows ground-glass opacities, blebs confined to the right upper lung apex, and diffuse ground-glass attenuation, blebs in the marginal areas, airspace consolidation, and fibrosis in the bilateral upper and lower lung fields.
Figure 4
Figure 4
Transverse view of the lower lung field. Chest computed tomography (CT) done post intubation shows ground-glass opacities, blebs confined to the right upper lung apex, and diffuse ground-glass attenuation, blebs in the marginal areas, airspace consolidation, and fibrosis in the bilateral upper and lower lung fields.
Figure 5
Figure 5
Coronal view of the whole lung field. Chest computed tomography (CT) done post intubation shows ground-glass opacities, blebs confined to the right upper lung apex, and diffuse ground-glass attenuation, blebs in the marginal areas, airspace consolidation, and fibrosis in the bilateral upper and lower lung fields.
Figure 6
Figure 6
Sagittal view of the whole lung field. Chest computed tomography (CT) done post intubation shows ground-glass opacities, blebs confined to the right upper lung apex, and diffuse ground-glass attenuation, blebs in the marginal areas, airspace consolidation, and fibrosis in the bilateral upper and lower lung fields.

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Source: PubMed

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