Outcome of four-dimensional stereotactic radiotherapy for centrally located lung tumors

LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective

“…9,36,[50][51][52][53]56,57,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] In terms of tumour dose, the LungTech protocol will investigate a medium hypofractionated approach, applying 8.0 3 7.5 Gy to a total dose of 60 Gy; this is equal to a BED of 105 Gy (a/b 5 10). Referring to report 83 of the International Commission on Radiation Units and Measurements (ICRU), 95% of the PTV has to receive at least the nominal fraction dose, and 99% of the PTV receives a minimum of 90% of the nominal dose.…”

Stereotactic Body Radiation Therapy for Oligometastases to the Lung: A Phase 2 Study

“…Clinical visits and CT scans were performed 3, 6,9,12,18,24,36,48, and 60 months after treatment. Followup PET scans were only obtained for evaluation of CT abnormalities.…”

“…Previous studies have shown potential for SBRT for the treatment of metastases to the lung (5)(6)(7)(8). For centrally located lesions, we reported recently a 2-year local control (LC) rate of 64% and 2-year overall survival (OS) rate of 75% (9). The potential role of SBRT in the management of oligometastatic disease has been highlighted in recent reviews (10)(11)(12)(13).…”

Stereotactic Body Radiotherapy: Do Central Lung Tumors Still Represent a ‘No-Fly Zone’?

“…Including patients with multiple ipsilateral mediastinal nodes, or those with any contralateral metastases, will inevitably increase doses to critical normal organs. Were high doses to the esophagus a reasontoexcludepatients,ortouseafractionsizeof5Gy,or even to accept lower tumor doses, as has been reported recently [8]? Further progress in this field requires detailed dosimetric data on esophageal and tracheal doses, which in turnmustbecorrelatedwithbothacuteandlatetoxicity.In addition,theuseofastagingPET-CTscaninlessthan50%of all their cases is of concern, as loco-regional recurrences developed in 11% of cases.…”

“…Recent reports from European groups who delivered SBRT to central tumors using so-called 'risk-adapted' fractionationschemes,inwhichdailydosefractionsof7.5Gyor lowerwereused,suggestthathighlocalcontrolratescanbe achievedwithminimaltoxicity [7,8].Apaperinthisissueby Janssen et al on 65 patients treated using SBRT at a single institutionprovidesfurtherinsightintotheuseofSBRTfor central tumors measuring up to 142 ml [9]. Included were 26patientswithstageIIINSCLC(n=16)orstageIVdisease (n = 10), with the latter comprising patients in whom treatmentoftheprimarywasjudgedtobenecessaryforsymptom controland/orqualityoflife.SBRTdeliverywasperformed withameticulousapproachusing4-dimensionalplanningCT scans, daily treatment setup on tumor position with conebeamCTscans,andperhapsmostimportantly,arisk-adapted SBRTschemedelivering8fractionsofeither6or5Gy.Treatment-related toxicity was acceptable, although the median follow-upof13.8monthsisrelativelyshort.Onedrawbackof thepaperisalackofdetailprovidedoninclusionorexclusion Onkologie2012;35:406-407…”