Analysis of pneumonitis and esophageal injury after stereotactic body radiation therapy for ultra-central lung tumors

Wang, Qianqian; Rimner, Andreas; Dick-Godfrey, Rosalind; McKnight, D.; Torres, D.; Flynn, Jessica; Zhang, Zhigang; Sidiqi, Baho; Jackson, Andrew; Wu, Abraham J.

doi:10.1016/j.lungcan.2020.07.009

Cited by 29 publications

(38 citation statements)

References 9 publications

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“…Tumours contacting the trachea and/or the proximal bronchial tree should be regarded as ultra-central tumours and thus, dose fractionation should be adapted to avoid potential severe toxicities such as stenosis, necrosis, stula, pulmonary haemorrhage and even pneumonitis [21]. Nevertheless, tumours whose PTV overlapped with oesophagus (1 grade 3 oesophagitis in our study) should also be taken into account, even if some trials decided against it [13,26].…”

Section: Discussionmentioning

confidence: 99%

Toxicity and efficacy of stereotactic body radiotherapy for ultra-central lung tumours: a single institution real life experience

Guillaume

Tanguy

Ayadi

et al. 2021

The British Journal of Radiology

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Objectives: The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. Our objective was to assess toxicities, local control (LC) rate and survival data in patients with ultra-central lung tumours treated with SBRT. Methods: We conducted a retrospective and monocentric study about 74 patients with an ultra-central lung tumour, consecutively treated between 2012 and 2018. Ultra-central tumours were defined as tumours whose planning target volume overlapped one of the following organs at risk (OARs): the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart. Results: Median follow-up was 25 months. Two patients (2.7%) showed Grade 3 toxicity. No Grade 4 or 5 toxicity was observed. 11% of patients experienced primary local relapse. LC rate was 96.7% at 1 year and 87.6% at 2 years. Median progression free survival was 12 months. Median overall survival was 31 months. Conclusion: SBRT for ultra-central tumours remains safe and effective as long as protecting organs at risk is treatment-planning priority. Advances in knowledge: The present study is one of the rare to describe exclusively ultra-central tumours through real-life observational case reports. Globally, literature analysis reveals a large heterogeneity in ultra-central lung tumours definition, prescribed dose, number of fractions. In our study, patients treated with SBRT for ultra-central lung tumours experienced few Grade 3 toxicities (2.7%) and no Grade 4 or 5 toxicities, due to the highest compliance with dose constraints to OARs. LC remained efficient.

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Section: Discussionmentioning

confidence: 99%

Toxicity and efficacy of stereotactic body radiotherapy for ultra-central lung tumours: a single institution real life experience

Guillaume

Tanguy

Ayadi

et al. 2021

The British Journal of Radiology

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Section: Discussionmentioning

confidence: 93%

“…Other studies about ultra-central SBRT found more grade ≥ 3 and grade 5 toxicities. Wang et al found 22% of grade ≥ 3 and 11% of grade 5, with 10% of patients who received antiangiogenic agents within 90 days of SBRT [20,21]. In Tekatli et al trial, 38% of patients had grade ≥ 3 toxicities and 21% had grade 5 [17].…”

Section: Discussionmentioning

confidence: 99%

Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

GUILLAUME

Tanguy

Ayadi

et al. 2021

Preprint

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Purpose: The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. We carried out a study about SBRT in patients with ultra-central lung tumours treated in our Cancer Centre. Our objectives were to assess toxicities, local control (LC) rate and survival data.Methods: We conducted a retrospective and monocentric study about 74 patients with an ultra-central lung tumour, consecutively treated between 2012 and 2018. Ultra-central tumours were defined as tumours whose PTV (planning target volume) overlapped one of the following organs at risk (OAR): the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart. Patients with primary or secondary tumour were enrolled in the study.Results: Median follow-up was 25 months. Two patients (2.7%) showed grade 3 toxicity. No grade 4 or 5 toxicity was observed. Eleven per cent of patients experienced primary local relapse. Local control rate was 96.7% at 1 year and 87.6% at 2 years. Median progression free survival (PFS) was 12 months. Median overall survival (OS) was 31 months. Conclusions: SBRT for ultra-central tumours remains safe and effective. Thus, SBRT can be considered to be well tolerated as long as protecting organs at risk remains treatment planning priority. Besides, as the results of ongoing prospective trial have not been published yet, SBRT for ultra-central tumours should be performed with caution.

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“…Early‐stage disease may be treated with resection in those amenable to surgery, whereas high‐dose stereotactic body radiotherapy (SBRT) may be utilized in those considered to be poor surgical candidates 6 . In this early‐stage patient cohort, local control rates of 70–90% are observed depending on tumor size, and treatment is typically associated with 1–22% grade 3 or higher toxicity depending on whether the tumor is located peripherally (lower rates of grade 3 toxicity) or centrally (higher rates of toxicity) 7 …”

Section: Introductionmentioning

confidence: 99%

“…6 In this early-stage patient cohort, local control rates of 70-90% are observed depending on tumor size, and treatment is typically associated with 1-22% grade 3 or higher toxicity depending on whether the tumor is located peripherally (lower rates of grade 3 toxicity) or centrally (higher rates of toxicity). 7 Among the patients with locally advanced NSCLC, those with limited stage IIIA nodal disease often have various treatment options, including combined-modality therapy with neoadjuvant chemotherapy/chemoradiation followed by surgery, surgery followed by chemotherapy, or definitive chemoradiation therapy followed by immunotherapy. 8 In contrast, patients with stage IIIB/IIIC (T1-4 N3 or T4 N2) are typically not amenable to surgery, and are treated with definitive chemoradiation followed by adjuvant immunotherapy with durvalumab.…”

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confidence: 99%

Carbon ion radiotherapy in the management of non‐small cell lung cancer

Seneviratne

Ishikawa

Mao

et al. 2022

Precision Radiation Oncology

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Despite advancements in local-regional and systemic therapies, non-small cell cancer (NSCLC) remains a leading cause of death worldwide. Among those treated with standard-of-care modalities, 30-60% experience disease recurrence. Carbon ion radiotherapy (CIRT) is a form of densely ionizing radiotherapy with unique physical and biological advantages over traditional photon and proton modalities. CIRT is expected to have a superior biological impact on tumors, and is believed to be less impacted by the presence of tumor hypoxia or cell cycle state. It also shows highly conformal physical dose deposition due to reduced lateral scattering of the particles, limiting the radiation dose delivered to adjacent organs at risk. To implement CIRT as a viable option in the treatment of NSCLC, technical aspects of treatment delivery -including appropriate beam arrangements, dose calculation algorithms, radiobiological models, and methods of motion management -must be thoroughly investigated. Furthermore, randomized clinical trials comparing CIRT versus traditional radiation modalities must be performed to show the benefits and risks associated with this novel treatment modality. This review discusses the rationale for utilizing CIRT in NSCLC, available clinical data to date, and the potential for future investigations that may pave the path for improving outcomes in those diagnosed with NSCLC. K E Y W O R D Scarbon ion, high-linear energy transfer, non-small cell lung cancer INTRODUCTIONWith nearly 1.79 million deaths per year, non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality worldwide. 1,2 Of the approximately 228,820 new cases of lung cancer diagnosed in the US in 2020, 84% were of the non-small cell variety.

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Analysis of pneumonitis and esophageal injury after stereotactic body radiation therapy for ultra-central lung tumors

Cited by 29 publications

References 9 publications

Toxicity and efficacy of stereotactic body radiotherapy for ultra-central lung tumours: a single institution real life experience

Toxicity and efficacy of stereotactic body radiotherapy for ultra-central lung tumours: a single institution real life experience

Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

Carbon ion radiotherapy in the management of non‐small cell lung cancer

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