Dose and Volume of the Irradiated Main Bronchi and Related Side Effects in the Treatment of Central Lung Tumors With Stereotactic Radiotherapy

Duijm, M.; Schillemans, W.; Aerts, Joachim; Heijmen, B.; Nuyttens, J.

doi:10.1016/j.semradonc.2015.11.002

Cited by 37 publications

(32 citation statements)

References 20 publications

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“…Organs at risk contouring was adopted from RTOG 0813, EORTC LungTech, SUNSET, and RTOG 1106 contouring atlas, and normal tissue constraints were adopted from RTOG 0813 and previous HILUS studies . Meanwhile, maximum point dose and volumetric maximum dose analyses were evaluated for OAR including esophagus, heart, pulmonary artery, pulmonary vein, spinal cord, ipsilateral lung, contralateral lung, lung total, trachea, mainstem bronchi, lobe bronchi, and proximal bronchial tree.…”

Section: Methodsmentioning

confidence: 99%

“…In the 2010s, a new subgroup within the cohort of patients with central tumors was designated as “high‐risk” or “ultra‐central” tumors, or those that abut the PBT . Ultra‐central tumors have increased grade 4+ toxicity, even with conservative radiotherapy fractionation .…”

Section: Introductionmentioning

confidence: 99%

“…11,12 In the 2010s, a new subgroup within the cohort of patients with central tumors was designated as "high-risk" or "ultra-central" tumors, or those that abut the PBT. 7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Ultra-central tumors have increased grade 4+ toxicity, even with conservative radiotherapy fractionation. 25 Of concern, Haseltine et al reported that in patients with PBT-abutting tumors who received conservative dose-fractionation SBRT plus bevacizumab, two patients experienced grade 5 pulmonary hemorrhages.…”

Section: Introductionmentioning

confidence: 99%

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Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

et al. 2019

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To determine the therapeutic efficacy and safety of risk‐adapted stereotactic body radiation therapy (SBRT) schedules for patients with early‐stage central and ultra‐central inoperable non‐small cell lung cancer. From 2006 to 2015, 80 inoperable T1‐2N0M0 NSCLC patients were treated with two median dose levels: 60 Gy in six fractions (range, 48‐60 Gy in 4‐8 fractions) prescribed to the 74% isodose line (range, 58%‐79%) for central lesions (ie within 2 cm of, but not abutting, the proximal bronchial tree; n = 43), and 56 Gy in seven fractions (range, 48‐60 Gy in 5‐10 fractions) prescribed to the 74% isodose line (range, 60%‐80%) for ultra‐central lesions (ie abutting the proximal bronchial tree; n = 37) on consecutive days. Primary endpoint was overall survival (OS); secondary endpoints included progression‐free survival (PFS), tumor local control rate (LC), and toxicity. Median OS and PFS were 64.47 and 32.10 months (respectively) for ultra‐central patients, and not reached for central patients. Median time to local failure, regional failure, and any distant failures for central versus ultra‐central lesions were: 27.37 versus 26.07 months, 20.90 versus 12.53 months, and 20.85 versus 15.53 months, respectively, all P < .05. Multivariate analyses showed that tumor categorization (ultra‐central) and planning target volume ≥52.76 mL were poor prognostic factors of OS, PFS, and LC, respectively (all P < .05). There was one grade 5 toxicity; all other toxicities were grade 1‐2. Our results showed that ultra‐central tumors have a poor OS, PFS, and LC compared with central patients because of the use of risk‐adapted SBRT schedules that allow for equal and favorable toxicity profiles.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

et al. 2019

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“…Subsequent studies using modestly protracted regimens of 50–60 Gy over 4–8 fractions have generally shown acceptable toxicity and good tumor control [4–6]. Toxicity studies evaluating the risks of SBRT have largely focused on the proximal bronchial tree, with rare treatment associated fatalities from hemoptysis or post-obstructive pneumonia [6–8], while fewer have focused on other central structures, particularly the heart.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Dose and Survival After Stereotactic Body Radiotherapy for Early-stage Non–Small-cell Lung Cancer

Tembhekar

Wright

Daly

2017

Clinical Lung Cancer

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Purpose/Objective Recent analyses identify cardiac dose as an important predictor of overall survival (OS) following chemoradiation for locally advanced non-small cell lung cancer (NSCLC). However, the survival influence of cardiac dose following stereotactic body radiation therapy (SBRT) is unknown. We performed a dose volume histogram (DVH) analysis of patients treated with SBRT for early stage NSCLC to examine survival and cardiac toxicity. Methods We reviewed the charts of patients treated with SBRT for early stage NSCLC between 6/2007–6/2015 and documented cardiac DVH parameters including maximum and mean dose, V5, V10, V20, and V30. Biologically effective doses and 2 Gy equivalent doses were also calculated. DVH parameters were assessed as predictors of OS using Cox regression. Results We identified 102 patients with 118 treated tumors. At a median follow-up of 27.2 months (range: 9.8–72.5 months), the 2-year OS estimate was 70.4%. Cardiac DVH parameters include [median (range)]: maximum: 14.2 Gy (0.3–77.8 Gy); mean: 1.6 Gy (0–12.6 Gy); V5: 8.7% (0–96.4%). We identified no correlation between OS and any cardiac dose parameter. No patient developed acute (within 3 month) cardiac toxicity. Four patients died of cardiac causes, all with pre-existing heart disease. Discussion In our cohort, cardiac dose was not a predictor of OS following lung SBRT, despite a subset of patients receiving high maximum cardiac doses. Based on our limited cohort, high doses to small volumes of heart appear safe. Analyses of larger patient cohorts with longer follow-up are needed to better delineate safe cardiac DVH constraints for SBRT.

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“…They showed in mid-bronchi and mainstem bronchi the 50% risk level to develop grade 1 radiographically evident side effects for a 5-fraction Dmax of 55 Gy and 65 Gy, respectively [22]. Therefore, considering the high risk of serious side effects, the identification and the adherence to precise dose constraints for the central airways is crucial.…”

Section: Literature Overview On Toxicities and Dosimetric Parametersmentioning

confidence: 99%

Organs at risk in lung SBRT

et al. 2017

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Dose and Volume of the Irradiated Main Bronchi and Related Side Effects in the Treatment of Central Lung Tumors With Stereotactic Radiotherapy

Cited by 37 publications

References 20 publications

Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

Cardiac Dose and Survival After Stereotactic Body Radiotherapy for Early-stage Non–Small-cell Lung Cancer

Organs at risk in lung SBRT

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