Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus

Song, Si Yeol; Choi, Won Ah; Shin, Seong Sik; Lee, Sangwook; Ahn, Seung Do; Kim, Jong Hoon; Je, Hyoung Uk; Park, Charn Il; Lee, Jung Shin; Choi, Eun Kyung

doi:10.1016/j.lungcan.2008.12.016

Cited by 170 publications

(132 citation statements)

References 35 publications

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“…Among those complications, radiation pneumonitis has been the most common; other reported causes are esophageal ulcers, lethal hemoptysis, and major airway stenosis 10,[18][19][20] . When performing sbrt for central tumours that are close to the mediastinal organs, it is necessary to pay attention to the relevant dose constraints.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results of Accelerated Hypofractionated Radiotherapy for Central-Type Small Lung Tumours

et al. 2017

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PurposeWe evaluated the efficacy and toxicity of accelerated hypofractionated radiotherapy (ahypof-rt) for central-type small lung tumours. MethodsBetween November 2006 and January 2015, 40 patients with central-type small lung tumours underwent ahypof-rt delivered using 10 MV X-rays and a coplanar 3-field technique. The number of fractions ranged from 24 to 28, with a fraction size of 2.5-3 Gy. A total dose of 69-75 Gy to the isocentre of the planning target volume was administered to each patient. Cumulative survival and local control rates were calculated using the Kaplan-Meier method. ResultsThe 27 men and 13 women enrolled in the study had a median age of 79 years (range: 60−87 years). The tumour stage was T1a in 9 patients, T1b in 17 patients, and T2a in 14 patients, with a median size of 26.5 cm (range: 11-49 cm). The median follow-up period was 23 months. A complete response was achieved in 3 patients (7.5%), and a partial response, in 17 patients (42.5%). The overall 2-year and 3-year local control rates were 87.3% and 81.8% respectively; the 2-year and 3-year overall survival rates were 78.9% and 66.7% respectively. Grade 3 pneumonitis occurred in 3 patients; no other severe adverse events (≥grade 3) were observed in any patient.Conclusions Accelerated hypofractionated radiotherapy using a fraction size of 2.5-3 Gy was highly safe and can be a more effective treatment option than conventional radiotherapy for patients with central-type small lung tumours.

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Section: Discussionmentioning

confidence: 99%

Clinical Results of Accelerated Hypofractionated Radiotherapy for Central-Type Small Lung Tumours

et al. 2017

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“…Recent studies have demonstrated that the lesion location (central versus peripheral) and the target volume size are strong predictors of toxicity when treating lung tumors with a hypo-fractionated SBRT regimen [12,13,15]. Timmerman et al reported that patients with central lesions treated to a total dose of 60-66 Gy in three fractions have an 11-fold increased risk of severe toxicity, compared to patients with peripheral lesions [12].…”

Section: Discussionmentioning

confidence: 99%

“…Timmerman et al reported that patients with central lesions treated to a total dose of 60-66 Gy in three fractions have an 11-fold increased risk of severe toxicity, compared to patients with peripheral lesions [12]. Song et al observed a 33% incidence of grades 3-5 pulmonary toxicities when treating central lesions in 3-4 consecutive days with daily doses of 10-20 Gy [13]. In the study by Fakiris et al, grades 3-5 toxicity occurred in 27% of patients with central lesions, compared to 10% of patients with peripheral tumors treated with a dose of 60-66 Gy in three fractions [15].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have proposed more precise classification schemes. For example, Song et al subdivided central tumors into peribronchial and endobronchial tumors, depending whether the lesion was within the zone of the proximal bronchial tree or immediately adjacent (and invading) the main bronchus [13]. De La Fuente Herman et al classified tumor location by dividing the chest cavity into three equal portions (peripheral right, central, and peripheral left) and considered a tumor as central if its margin touched the central region [14].…”

Section: Introductionmentioning

confidence: 99%

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A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

et al. 2012

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Purpose: Stereotactic body radiation therapy is an emerging technique in the treatment of peripheral lung tumors. However, due to early reports of increased toxicity, the treatment of central lung lesions with hypo-fractionated high-dose regimen remains controversial. Thus far, lung lesions have been defined as either central or peripheral depending solely on their nearest distance from the major airways. The goal of this study is to develop a quantitative method to categorize the location of lung lesions mapped in three-dimensional space. Furthermore, a set of parameters are proposed for assessing risk factors based on target locations. Methods and Materials: A MATLAB program was developed to quantify the distance between the tumor and the airways, and to calculate the percentage of the target volume lying within a given distance from the main bronchial tree. The program was tested on 20 patients with centrally located lung lesions treated with CyberKnife. A dosimetric analysis was performed to investigate the relationship between dose delivered to the critical structures and target location. Results: The absolute target volume located within a distance of 20 mm from the airways was used to quantify the tumor proximity to the bronchial tree. A strong correlation was found between this parameter and the dose delivered to the critical organs, showing that a detailed knowledge of target location can be used to assess the risk of toxicity during the planning stage. Conclusions: We have developed a tool to quantify the lesion proximity to the bronchial tree. We expect that riskadapted strategies, accounting for the exact geometric relationship between the tumor and the airways, may improve the management of centrally located lung lesions.

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“…Stereotactic body radiotherapy (SBRT), with a 3-year local control rate of 80∼90%, has been suggested as an alternative treatment option in these patients. 1,2) In recent series, the results of SBRT were comparable or better than those for sublobar resection. [3][4][5] Several studies reported that higher biologically equivalent dose was related to improved local control and survival.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

2015

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The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at 2 nd , 3 rd , and 4 th CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p＜0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, V20 Gy, D1500 cc, and D1000 cc of lung were significantly decreased (p＜0.05), and V30 Gy and V32 Gy of the chest wall were also decreased (p＜0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

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Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus

Cited by 170 publications

References 35 publications

Clinical Results of Accelerated Hypofractionated Radiotherapy for Central-Type Small Lung Tumours

Clinical Results of Accelerated Hypofractionated Radiotherapy for Central-Type Small Lung Tumours

A new method to characterize target location in lung cancer patients treated with stereotactic body radiation therapy

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

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