Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with “Ultracentral” Non–Small Cell Lung Cancer

Tekatli, H.; Haasbeek, N.; Dahele, Max; Haan, Patricia de; Verbakel, Wilko F.A.R.; Bongers, E.; Hashemi, S.; Nossent, Esther J.; Spoelstra, F.; Langen, Adrianus J. de; Slotman, Ben J.; Senan, Suresh

doi:10.1016/j.jtho.2016.03.008

Cited by 174 publications

(165 citation statements)

References 25 publications

(37 reference statements)

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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%

“…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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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Tekatli et al 84,85 report the outcomes of 80 patients with tumour PTV within 2 cm of the proximal bronchial tree and 47 patients with more ultracentral tumours, defined as the PTV in contact with the trachea or main bronchi. The patients were treated with 60 Gy/ 8# (BED for tissue with an alpha/beta ratio of 10 5 105 Gy).…”

Section: Sabr For Central Lesions In Lung Cancermentioning

confidence: 99%

“…Fatal pulmonary haemorrhage was observed in 15% of patients. 85 The promising reported outcomes and toxicity profile, as well as the prognostic sequelae of not adequately treating ES central lung cancer would suggest that SABR will be offered to these patients with increasing frequency. 86 However, those patients with tumours involving the trachea or main bronchus will be at a much higher risk of treatment toxicity, including death.…”

Section: Sabr For Central Lesions In Lung Cancermentioning

confidence: 99%

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Murray

Franks

Hanna

2017

The British Journal of Radiology

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Stereotactic ablative body radiotherapy (SABR) describes a radiotherapy (RT) technique where high doses of radiation are precisely delivered to an extracranial target within the body, using either a single fraction of RT or using multiple small numbers of fractions. SABR has now become the standard of care treatment for patients with early-stage non-small-cell lung cancer (NSCLC) for whom surgery is not appropriate. This systematic review considers the evidence supporting the use of SABR in early-stage NSCLC, reported toxicity rates, the use of SABR in centrally located NSCLC, the use of SABR as salvage therapy following surgery or RT, and future potential drug combinations with SABR.

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“…Some reports have discussed the definition of ultracentral lung cancer. Tekatli et al . defined “ultracentral” lung cancer as centrally located NSCLC with planning target volume (PTV) overlapping the trachea or main bronchi.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non‐small cell lung cancer

et al. 2020

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Background There is no consensus on the definition or recommended radiotherapy treatment of ultracentral non‐small cell lung cancer (NSCLC). Here, we report our institution's experience in treating ultracentral lung cancer patients with stereotactic ablative radiotherapy (SABR) of 60 Gy in eight fractions. Methods We retrospectively reviewed the outcomes of 21 ultracentral NSCLC patients treated with 60 Gy SABR in eight fractions. We defined ultracentral lung cancer as the planning target volume (PTV) directly abutting or overlapping central structures, including the proximal bronchial tree, heart, and great vessels but not the esophagus. The Kaplan‐Meier method was used to estimate overall survival (OS), progression‐free survival (PFS) and local control (LC). Toxicity was scored per the CTCAE v4.03. Results The median follow‐up time was 15 months, and the median OS was 15 months. The one‐ and two‐year OS rates were 87.5% and 76.6%, respectively. The one‐ and two‐year PFS rates were 71.1% and 64.0%, respectively. The one‐ and two‐year LC rates were 92.9% and 92.9%, respectively. The rate of grade 2 treatment‐related toxicities was 19.1%. There was no grade ≥ 3 treatment‐related toxicity. Conclusion SABR of 60 Gy in eight fractions is feasible for ultracentral NSCLC.

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Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with “Ultracentral” Non–Small Cell Lung Cancer

Cited by 174 publications

References 25 publications

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

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

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non‐small cell lung cancer

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