An Analysis of Clinical Toxic Effects and Quality of Life as a Function of Radiation Dose and Volume After Lung Stereotactic Body Radiation Therapy

Devpura, Suneetha; Feldman, Aharon; Rusu, Samuel; Mayyas, Essa; Movsas, Avielle; Brown, Stephen L.; Cook, Andrew; Simoff, Michael; Sun, Zhenliang; Lü, Mei; Vance, Sean; Ajlouni, Munther; Siddiqui, M. Salim; Chetty, Indrin J.; Movsas, Benjamin

doi:10.1016/j.adro.2021.100815

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…24 In contrast, single-center papers often report only clinically significant events without standardized definitions. The composite rate of major complications in NAVABLATE (13.3%) is similar to the pooled major complication rates reported in the meta-analyses of percutaneous thermal ablation by Jiang et al (11.5%), 6 Li et al (6%), 25 and Lyons et al (range 7% to 33%) 26 and those reported for SBRT by Devpura et al (5.5%), 27 Timmerman et al (16.4%), 28 and Nyman et al (14.6%). 29 Based on the data in NAVABLATE, transbronchial MWA has a lower pneumothorax rate than percutaneous thermal ablation and a similar adverse event rate to SBRT.…”

Section: Discussionsupporting

confidence: 84%

Transbronchial Microwave Ablation of Peripheral Lung Tumors

Lau,

Baranowski

et al. 2023

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Image-guided thermal ablation is a minimally invasive local therapy for lung malignancies. NAVABLATE characterized the safety and performance of transbronchial microwave ablation (MWA) in the lung. Methods: The prospective, single-arm, 2-center NAVABLATE study (NCT03569111) evaluated transbronchial MWA in patients with histologically confirmed lung malignancies ≤30 mm in maximum diameter who were not candidates for, or who declined, both surgery and stereotactic body radiation therapy. Ablation of 1 nodule was allowed per subject. The nodule was reached with electromagnetic navigation bronchoscopy. Cone-beam computed tomography was used to verify the ablation catheter position and to evaluate the ablation zone postprocedure. The primary end point was composite adverse events related to the transbronchial MWA device through 1-month follow-up. Secondary end points included technical success (nodule reached and ablated according to the study protocol) and technique efficacy (satisfactory ablation based on 1-month follow-up imaging). Results: Thirty subjects (30 nodules; 66.7% primary lung, 33.3% oligometastatic) were enrolled from February 2019 to September 2020. The pre-procedure median nodule size was 12.5 mm (range 5 to 27 mm). Procedure-day technical success was 100% (30/30), with a mean ablative margin of 9.9±2.7 mm. One-month imaging showed 100% (30/30) technique efficacy. The composite adverse event rate related to the transbronchial MWA device through 1-month follow-up was 3.3% (1 subject, mild hemoptysis). No deaths or pneumothoraces occurred. Four subjects (13.3%) experienced grade 3 complications; none had grade 4 or 5. Conclusion: Transbronchial microwave ablation is an alternative treatment modality for malignant lung nodules ≤30 mm. There were no deaths or pneumothorax. In all, 13.3% of patients developed grade 3 or above complications.

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Section: Discussionsupporting

confidence: 84%

Transbronchial Microwave Ablation of Peripheral Lung Tumors

Lau,

Baranowski

et al. 2023

Journal of Bronchology &Amp; Interventional Pulmonology

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“…The first is the lower risk of radiation pneumonitis; the sharp dose distribution of CIRT has the advantage of decreased dosing to normal lung tissue [ 23 , 54 ]. Indeed, the doses to the lungs in the present study were sufficiently low across all indices, with notable differences from previous SBRT studies, particularly the mean lung dose (MLD) and lung V5 [ 14 , 55 , 56 , 57 ]. In recent years, in addition to lung V20 [ 51 , 52 ], low-dose lung areas, evaluated using lung V5, 10, etc., and MLD have received increased attention as indicators of dose-associated clinical pneumonitis [ 14 , 55 , 56 , 57 ].…”

Section: Discussioncontrasting

confidence: 71%

“…Indeed, the doses to the lungs in the present study were sufficiently low across all indices, with notable differences from previous SBRT studies, particularly the mean lung dose (MLD) and lung V5 [ 14 , 55 , 56 , 57 ]. In recent years, in addition to lung V20 [ 51 , 52 ], low-dose lung areas, evaluated using lung V5, 10, etc., and MLD have received increased attention as indicators of dose-associated clinical pneumonitis [ 14 , 55 , 56 , 57 ]. The reduced low-dose lung area may have led to lower toxicity.…”

Section: Discussioncontrasting

confidence: 71%

Long-Term Outcomes of Ablative Carbon-Ion Radiotherapy for Central Non-Small Cell Lung Cancer: A Single-Center, Retrospective Study

Aoki,

Ishikawa,

Nakajima

et al. 2024

Cancers

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The aim of this study is to assess the efficacy and safety of ablative carbon ion radiotherapy (CIRT) for early stage central non-small cell lung cancer (NSCLC). We retrospectively reviewed 30 patients who had received CIRT at 68.4 Gy in 12 fractions for central NSCLC in 2006–2019. The median age was 75 years, and the median Karnofsky Performance Scale score was 90%. All patients had concomitant chronic obstructive pulmonary disease, and 20 patients (67%) were considered inoperable. In DVH analysis, the median lung V5 and V20 were 15.5% and 10.4%, and the median Dmax, D0.5cc, D2cc of proximal bronchial tree was 65.6 Gy, 52.8 Gy, and 10.0 Gy, respectively. At a median follow-up of 43 months, the 3-year overall survival, disease-specific survival, and local control rates were 72.4, 75.8, and 88.7%, respectively. Two patients experienced grade 3 pneumonitis, but no grade ≥3 adverse events involving the mediastinal organs occurred. Ablative CIRT is feasible and effective for central NSCLC and could be considered as a treatment option, especially for patients who are intolerant of other curative treatments.

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“…Indeed, dosing to the lungs in the present study was su ciently low across all indices, but the most remarkable differences from previous SBRT studies [14,[54][55][56] were the mean lung dose (MLD) and lung V5, which were clearly lower than those in lung V20. In recent years, in addition to lung V20 [49,50], lung low-dose areas, evaluated using lung V5, 10, etc., and MLD, have received increased attention as indicators of dose-associated clinical pneumonitis [14,[54][55][56]. A reduced low-dose lung area may have led to lower toxicity.…”

Section: Cirt Safetycontrasting

confidence: 81%

Long-term outcomes of high-dose carbon-ion radiotherapy for central non-small cell lung cancer: a single-centre, retrospective study.

Aoki

Nakajima

Ishikawa

et al. 2023

Preprint

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Background The feasibility and efficacy of radiation therapy (RT) for central non-small cell lung cancer (NSCLC) remain controversial owing to the increased risk of severe adverse events (AEs), including pneumonia, perforation of mediastinal organs (esophagus and trachea), and bleeding. Carbon-ion radiation therapy (CIRT) is an effective RT modality owing to its steep dose distribution and high biological efficacy. We retrospectively analyzed the clinical course of central NSCLC treated using CIRT. Methods Thirty patients who received CIRT with 68.4 Gy (RBE) in 12 fractions for pathologically proven central NSCLC between 2006 and 2018 were reviewed. The clinical stage was re-evaluated according to the UICC 8th edition, and adverse events were evaluated using CTCAE ver.5.0. The Kaplan–Meier method was used to evaluate overall survival (OS), disease-specific survival (DSS), and local control (LC). Results The median age was 75 years (range 55–85). All patients had concomitant chronic obstructive pulmonary disease (COPD), and 20 (67%) were regarded as inoperable. At a median follow-up of 63 months in surviving patients, 14 patients died, but no treatment-related deaths were observed. The 3-year OS, DSS, and LC rates were 72.4, 75.8, and 88.7%, respectively. Two patients experienced grade 3 pneumonitis, representing 6.7% of the cohort, but no grade ≥ 3 AEs involving the mediastinal organs occurred. Conclusions CIRT using our dose fractionation is feasible and effective for central NSCLC and may be a secure treatment option for patients with central NSCLC who are unmet for other curative treatments.

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An Analysis of Clinical Toxic Effects and Quality of Life as a Function of Radiation Dose and Volume After Lung Stereotactic Body Radiation Therapy

Abstract: An analysis of clinical toxicity and quality of life as a function of radiation dose and volume after lung stereotactic body radiation therapy (SBRT), Advances in Radiation Oncology (2021), doi:

Cited by 7 publications

References 26 publications

Transbronchial Microwave Ablation of Peripheral Lung Tumors

Transbronchial Microwave Ablation of Peripheral Lung Tumors

Long-Term Outcomes of Ablative Carbon-Ion Radiotherapy for Central Non-Small Cell Lung Cancer: A Single-Center, Retrospective Study

Long-term outcomes of high-dose carbon-ion radiotherapy for central non-small cell lung cancer: a single-centre, retrospective study.

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