Early Clinical Outcome of the First Lung SBRT Program in Jordan: Importance of International Collaboration

Background: The stereotactic radiotherapy (SBRT) program was established at King Hussein Cancer Center (KHCC) in Jordan through cooperation with an internationally renowned institution MD Anderson Cancer Center (MDACC) in USA, and it went clinical in 2012. Until the present day, it stands as the only SBRT program in the entire country with patient population that has increased in the past few years due influx of refugees from regional conflicts. In this presentation, we will present the clinical outcome of our SBRT program. Methods: 17 patients treated to date in the SBRT service. All patients underwent 10-phase 4DCT and PET-CT scans. The internal target volume (ITV) was constructed from the minimum intensity projection (MIP) dataset and expanded, if needed, following PET findings. 5 mm margin added to create the PTV. A dose scheme of 48 Gy in 4 fractions or 50 Gy/4 fractions were used for all patients except for two patients who received 60 Gy in 8 fractions due to toxicity concerns. Lung heterogeneity correction was used during planning and treatment delivery was done on Elekta Precise Linear Accelerator and using CBCT imaging for positioning for every fraction. Follow- up done by performing CT chest 3 months after completion of SBRT, and CT/PET every 6 months in the two years, CT chest every 4-6 months thereafter, and keeping CT/PET whenever indicated. Results: All patients treated were males except one, with age ranging from 50-84 years old (mode of 79). All patients were unfit for surgery except for one who refused surgery. All patients except one are alive with only one patient recurred locally. One patient died not due to cancer. Conclusion: The newly established SBRT clinical service in our country, serves as the only such treatment of a population of 9.5 million including 2.5 million refugees. We have started recruiting inoperable lung patients to the service at a slow pace to gain more confidence and experience before admitting larger number of patients. Clinical results are encouraging with most showing tumor regression/complete response as of last follow-up. This model of collaboration between KHCC and MDACC represents a successful scientific collaboration between cancer centers in developed and developing countries that lead to effective and safe implementation of new techniques and procedures.