Stereotactic body radiotherapy for centrally‑located lung tumors with 56�Gy in seven fractions: A retrospective study

Aoki, Shuri; Yamashita, Hideomi; Haga, Akihiro; Ota, Takayo; Takahashi, Wataru; Ozaki, Sho; Nawa, K.; Imae, Toshikazu; Abe, Osamu; Nakagawa, Keiichi

doi:10.3892/ol.2018.9188

Cited by 7 publications

(20 citation statements)

References 51 publications

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“…Two reports with three and four ultra-central patients, respectively, were also excluded due to small sample sizes, with one reporting no toxicity (0 of 3 patients) and the other not directly reporting the toxicity rate for patients considered ultra-central. 32,33 We believe that our results will shed light on the feasibility of SABR for ultra-central lung lesions, as well as provide guidance on patient selection so that those patients at higher risk are adequately counselled on the competing risks and benefits of SABR. 34 Ultimately, further prospective research in this setting is needed to define the optimal dose and fractionation of radiation for ultra-central tumors, and the results of one such study (SUNSET: SABR for Ultra-central NSCLC: A Safety and Efficacy Trial, NCT03306680) are awaited.…”

Section: Discussionmentioning

confidence: 85%

Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review

Chen

Laba

Zayed

et al. 2019

Journal of Thoracic Oncology

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Introduction: The safety and effectiveness of stereotactic ablative radiotherapy (SABR) in patients with ultra-central lung tumors is currently unclear. We performed a systematic review to summarize existing data and identify trends in treatment-related toxicity and local control following SABR in patients with ultra-central lung lesions. Methods: We performed a systematic review based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines using the PubMed and Embase databases. The databases were queried from dates of inception until September 27, 2018. Studies in the English language that reported treatment-related toxicity and local control outcomes post-SABR for patients with ultra-central lung lesions were included. Guidelines, reviews, non-peer reviewed correspondences, studies focused on re-irradiation, and studies with fewer than five patients were excluded. Results: A total of 446 studies were identified, with 10 meeting all criteria for inclusion. The total sample size from the identified studies was 250 ultra-central lung patients and all studies were retrospective in design. Radiotherapy dose and fractionation ranged from 30 to 60 Gy in 3 to 12 fractions, with biologically effective doses (BED 10) ranging from 48 to 138 Gy 10 (median, 78-103 Gy 10). Median treatment-related grade 3 or greater toxicity was 10% (range, 0-50%). Median treatmentrelated mortality was 5% (range, 0-22%), most commonly from pulmonary hemorrhage (55%). High-risk indicators for SABR-related mortality included gross endobronchial disease, maximum dose to the proximal bronchial tree greater than or equal to 180 Gy 3 (BED 3 , corresponding to 45 Gy in 5 fractions or 55 Gy in 8 fractions), peri-SABR bevacizumab use, and antiplatelet/ anticoagulant use. Median 1-year local control rate was 96% (range, 63%-100%) and 2-year local control rate was 92% (range, 57%-100%). Conclusions: SABR for ultra-central lung lesions appears feasible but there is a potential for severe toxicity in patients receiving high doses to the proximal bronchial tree, those with endobronchial disease, and those receiving bevacizumab or anticoagulants around the time of SABR. Prospective studies are required to establish the optimal doses, volumes, and normal tissue tolerances for SABR in this patient population.

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Section: Discussionmentioning

confidence: 85%

Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review

Chen

Laba

Zayed

et al. 2019

Journal of Thoracic Oncology

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“…There was no significant difference in treatment outcome between the two methods (41). VMAT plans were designed using a single partial arc with angle ranges of -40˚ to 180˚ (left lung) or -180˚ to 40˚ (right lung), as previously detailed (37,38,41,42). dosimetric planning and plan analysis were performed using Pinnacle 3 .…”

Section: Methodsmentioning

confidence: 99%

“…dosimetric planning and plan analysis were performed using Pinnacle 3 . The collapsed cone convolution method (comparable to the superposition method) in the TPS was used (42,43). All final calculations were performed using a grid size of 2.0 mm.…”

Section: Methodsmentioning

confidence: 99%

Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

et al. 2020

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A standard treatment for patients with early-stage non-small cell lung cancer (NSCLC) who undergo surgery, and subsequently develop local failure or intrathoracic oligorecurrence, has not yet been established. The present study aimed to assess the feasibility of stereotactic body radiotherapy (SBRT) for this subgroup of patients. Consequently, a retrospective analysis was conducted of patients with NSCLC recurrence who were treated with SBRT, and previously underwent curative surgical resection between October 2011 and October 2016. Post-SBRT survival [overall survival (OS); progression-free survival (PFS); and local control (LC)] and toxicity were analyzed. Prognostic factors for OS were identified using univariate and multivariate analysis. A total of 52 patients and 59 tumors were analyzed. The median follow-up time was 25 months (35 months for surviving patients), and median OS following salvage SBRT was 32 months. The 1-and 3-year OS rates were 84.4 and 67.8%, respectively. 1-and 3-year PFS rates were 80.8 and 58.7%, respectively. Only 4 patients (7.7%) developed local failure. Median LC was 71 months and 1-and 3-year LC rate were 97.9 and 94.9%, respectively. A total of 4 patients experienced grade 3 or higher adverse events (AEs) and two experienced grade 5 AEs (pneumonitis and hemoptysis). Central tumor location and the possibility of re-operation were independent prognostic factors for OS. The present study indicated that post-operative salvage SBRT is a promising therapeutic option for patients with NSCLC with locoregional or intrathoracic oligo-recurrence. We regard toxicity was also acceptable. However, further research is required on the appropriate selection of subjects, and stratification of the analysis by certain risk factors would increase the accuracy of the conclusions.

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“…Data on treating central thoracic metastases with SBRT is limited, as the delivery of SBRT within the NFZ has been controversial since an early study in NSCLC demonstrated severe toxicity and high rates of treatment-related death [4]. Although several retrospective studies have now demonstrated that moderately central primary and metastatic tumours can be treated safely using moderated dose fractionations [5,6,[8][9][10]18], other studies report high toxicity rates [19,20]. The evidence for ultra-central tumours is more equivocal.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for moderately central and ultra-central oligometastatic disease: Initial outcomes

Cooke

Camilleri

Chu

et al. 2020

Technical Innovations & Patient Support in Radiation Oncolo

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Background: Delivery of SBRT to central thoracic tumours within 2 cm of the proximal bronchial tree (PBT), and especially ultra-central tumours which directly abut the PBT, has been controversial due to concerns about high risk of toxicity and treatment-related death when delivering high doses close to critical mediastinal structures. We present dosimetric and clinical outcomes from a group of oligometastatic patients treated with a risk-adapted SBRT approach. Methods: Between September 2015 and October 2018, 27 patients with 28 central thoracic oligometastases (6 moderately central, 22 ultra-central) were treated with 60 Gy in 8 fractions under online CBCT guidance. PTV dose was compromised where necessary to meet mandatory OAR constraints. Patients were followed up for toxicity and disease status. Results: Mandatory OAR constraints were met in all cases; this required PTV coverage compromise in 23 cases, with V100% reduced to <70% in 11 cases. No acute or late toxicities of Grade 3 were reported. One and 2 year in-field control rates were 95.2% and 85.7% respectively, progression-free survival rates were 42.8% and 23.4% respectively, and overall survival rates were 82.7% and 69.5% respectively. No significant differences were seen in control or survival rates by extent of PTV underdosage or between moderately and ultra-central cases. Conclusion: It appears that compromising PTV coverage to meet OAR constraints allows safe and effective delivery of SBRT to moderately and ultra-central tumours, with low toxicity rates and high in-field control rates. This treatment can be delivered on standard linear accelerators with widely available imaging technology.

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Stereotactic body radiotherapy for centrally‑located lung tumors with 56�Gy in seven fractions: A retrospective study

Cited by 7 publications

References 51 publications

Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review

Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review

Salvage stereotactic body radiotherapy for post‑operative oligo‑recurrence of non‑small cell lung cancer: A single‑institution analysis of 59�patients

Stereotactic body radiotherapy for moderately central and ultra-central oligometastatic disease: Initial outcomes

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