Stereotactic Body Radiotherapy for Central Lung Tumors

Rowe, B.P.; Boffa, Daniel J.; Wilson, Lynn D.; Kim, Anthony W.; Detterbeck, Frank C.; Decker, Roy H.

doi:10.1097/jto.0b013e3182614bf3

Cited by 113 publications

(86 citation statements)

References 15 publications

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“…Potential disadvantages are the limited availability of long-term follow-up data [136], lack of information about micrometastatic disease in lymphatics, and an increased risk (,10%) of severe and fatal adverse events when centrally located lesions are treated [137,138]. Local control and complication rates are dose-dependent.…”

Section: Nonsurgical Optionsmentioning

confidence: 99%

Slow-growing lung cancer as an emerging entity: from screening to clinical management

et al. 2013

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The current paradigm is that untreated lung cancer is invariably and rapidly fatal, therefore the medical community normally dismisses the idea that a patient could live with such a disease for years without any therapy.Yet evidence from lung cancer screening research and from recent clinical series suggests that, although rarely recognised in routine practice, slow-growing lung cancers do exist and are more common than previously thought.Here, current evidence is reviewed and clinical cases are illustrated to show that slow-growing lung cancer is a real clinical entity, and the reasons why management protocols developed in the screening setting may also be useful in clinical practice are discussed. Features suggesting that a lung cancer may be slow-growing are described and appraised, areas of uncertainty are examined, modern management options for earlystage disease are evaluated and the influence that all this knowledge might have on our clinical decisionmaking is weighed. Further research directed at developing appropriate guidelines for these peculiar but increasingly common patients is warranted. @ERSpublications The increasingly common incidence of slow-growing lung cancer and its influence on clinical decision-making is discussed

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Section: Nonsurgical Optionsmentioning

confidence: 99%

Slow-growing lung cancer as an emerging entity: from screening to clinical management

et al. 2013

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“…For endotracheal CTLC, many thermal ablation approaches have been developed to relieve the distressing breathlessness, cough and obstructive pneumonia and improve respiratory function and performance status, including photodynamic therapy [7,26], brachytherapy [20,21], laser therapy [6], airway stenting [22] and endobronchial cryosurgery [15]. Among patients with extratracheal CTLC, only a minority are candidates for surgery [12,16,30], and chemotherapy and external beam radiation therapy have not greatly affected patient outcomes [5,23]. However, many thermal ablation methods can significantly improve quality of life and prolong survival time, including radiofrequency ablation, microwave ablation and cryoablation [25].…”

Section: Discussionmentioning

confidence: 99%

Treatment of central type lung cancer by combined cryotherapy: Experiences of 47 patients

Zhang¹,

Niu²,

Liang³

et al. 2013

Cryobiology

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“…Indeed, radiation necrosis has been infrequently reported in SABR-literature. There are other three cases of bronchial necrosis that resulted in different clinical scenarios, i.e., fatal hemoptysis (28), atelectasis (29) and bronchial fistula formation (30). Regarding the difficulty to distinguish SABR complications from those of exacerbation of cardiopulmonary comorbidity, the reader is referred to our previous discourse on this issue (31).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

et al. 2017

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Background: The net benefit from local ablative therapy for pulmonary oligometastases remains unknown.The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs). Methods: Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni-and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints. Results: Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dosefractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or <12 Gy) was an independent predictor for LC (P=0.02) and PFS (P=0.01) for the whole population, and for PFS (P=0.02) in the PLLs group. Late toxicities ≥ G2 occurred in six patients with PLLs, compared with none in the metastatic group. Conclusions: SABR for MLLs was as successful as for PLLs with respect to LC and OS with lower longterm toxicity in patients with MLLs. Dose per fraction ≥12 Gy turned out to be an independent, favorable prognostic factor. IntroductionBased on conceptual theories of breast cancer growth and dissemination, Hellman and Weichselbaum inferred the existence of a clinically and biologically relevant group of oligometastatic patients, in whom aggressive local therapy may prolong survival and even be a curative treatment option (1). The incentive for using stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) came from favorable results of surgical removal of oligometastases in different types of solid tumors (2). High rates of survival in treated compared with untreated patients have also been demonstrated for lung metastasectomy (3). However, the temporal and locational burden of oligometastatic state remains blurred and diffuse and-until now-no clear guidelines have been defined for the selection of patients who would really benefit from local ablative treatment.During the past decade, SABR emerged as a new standard of care for medically inoperable patients with early stage non-small-cell lung cancer. For oligometastatic diseases the benefit from SABR has been extrapolated from the experience with pr...

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Stereotactic Body Radiotherapy for Central Lung Tumors

Abstract: SBRT for central lung tumors seems to be safe, although treatment of larger tumors does carry an increased risk of high-grade toxicity. Efforts to decrease the toxicity risk by decreasing the biologically equivalent dose resulted in increased local failure.

Cited by 113 publications

References 15 publications

Slow-growing lung cancer as an emerging entity: from screening to clinical management

Slow-growing lung cancer as an emerging entity: from screening to clinical management

Treatment of central type lung cancer by combined cryotherapy: Experiences of 47 patients

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

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