Subgroup Survival Analysis in Stage I-II NSCLC Patients With a Central Tumor Partly Treated With Risk-Adapted SBRT

Stam, Barbara; Kwint, Margriet; Gückenberger, Matthias; Mantel, Frederick; Hope, Andrew; Giuliani, Meredith; Werner‐Wasik, Maria; Grills, I.S.; Sonke, Jan‐Jakob; Belderbos, J.

doi:10.1016/j.ijrobp.2018.08.040

Cited by 22 publications

(12 citation statements)

References 30 publications

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“…Moreover, a study by Stam et al demonstrated that patients who underwent SBRT to central lung tumors located within the first centimeter surrounding the proximal bronchial tree were more likely to die from causes other than cancer compared to other patients [26]. The authors detected that high dose to the proximal bronchial tree (D 1%) was significantly associated with noncancer death (p = 0.003).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors

Zhao

Khawandanh²,

Thomas³

et al. 2020

Radiat Oncol

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Background: For stereotactic body radiotherapy (SBRT) to central (C) and ultracentral (UC) lung tumors, our provincial practice has been to prioritize organs at risk (OARs) constraints by compromising target volume coverage if needed. The objectives are to report the treatment's efficacy and safety. Methods: We conducted a retrospective analysis of all provincial patients who underwent SBRT at 60Gy in 8 fractions to C and UC lung tumors, from 2013 to 2017. Results: Ninety-eight lesions were treated, 57 (58.2%) C and 41 (41.8%) UC. The median follow-up was 22.9 months (range 2.5-64.8 months). The 1-and 3-year local control (LC) was 97.8 and 84.5% respectively, with no differences between C and UC groups (p = 0.662). Fifty-three (54.1%) cases had optimal dose coverage (V60Gy ITV&PTV > 95%), 29 (29.6%) had compromised PTV coverage (V60Gy ITV > 95%/PTV < 95%), and 16 (16.3%) had both compromised ITV and PTV coverage (V60Gy ITV&PTV < 95%). No significant difference in LC was detected at 2 years between the 3 groups (95.6, 91.8 and 90.9%, p = 0.717). There were 3 episodes of grade 3 toxicity in the C group (2 dyspnea, 1 pneumonitis) and 2 in the UC group (1 dyspnea, 1 hemoptysis). There were no gr4/5 toxicities. On multivariable Cox regression analysis, ITV size was found to be a predictor for LC (p = 0.001). Conclusions: SBRT at 60Gy in 8 fractions achieves high rates of LC with low risks of significant toxicities, even if target volume coverage is reduced to meet OARs constraints.

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Section: Discussionmentioning

confidence: 99%

Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors

Zhao

Khawandanh²,

Thomas³

et al. 2020

Radiat Oncol

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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%

“…Organs at risk contouring was adopted from RTOG 0813, 35 EORTC LungTech, 36 SUNSET, 18 and RTOG 1106 contouring atlas, 37 and normal tissue constraints were adopted from RTOG 0813 and previous HILUS studies. 6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] 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. Treated doses were converted to biologically effective doses (BED) based on the formula: nd [1 + d/(α/β)], where n is number of fractions, and d is dose/fraction (Gy); assuming α/β value of 10 for NSCLC (ie BED 10 ) and α/β value of 3 for normal tissues (ie BED 3 ).…”

Section: Organs At Risk Normal Tissue Constraints and Biologicallmentioning

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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The impact of apelin-13 on cisplatin-induced endocrine pancreas damage in rats: an in vivo study

Ciftel,

Tumkaya,

Saral

et al. 2024

Histochem Cell Biol

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Subgroup Survival Analysis in Stage I-II NSCLC Patients With a Central Tumor Partly Treated With Risk-Adapted SBRT

Cited by 22 publications

References 30 publications

Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors

Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors

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

The impact of apelin-13 on cisplatin-induced endocrine pancreas damage in rats: an in vivo study

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