Stereotactic Body Radiotherapy for Lung Tumors at the Pulmonary Hilum

Oshiro, Yoshiko; Akiyoshi, Takashi; Tsuboi, Koji; Marino, Kan; Hara, Ryusuke; Sanayama, Yasushi; Itami, Jun

doi:10.1007/s00066-010-2072-y

Cited by 53 publications

(25 citation statements)

References 35 publications

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“…In reports on SBRT of centrally located tumors, on the other hand, 2-year LCR ranges from 60 (29) to 94% (30). This is thought to be related to the lower BED 10 used to avoid severe AEs.…”

Section: Discussionmentioning

confidence: 99%

“…Andratschke et al reported a 3-year LCR of 64%, and OS of 29% (32). Oshiro et al reported a 2-year LCR of 60% with BED 10 =80 Gy (29), and Bradley et al reported an 86% 2-year LCR, and 75% 2-year OS with BED 10 =86 Gy (33). As for reports of ≥100 Gy, Timmerman et al reported a 2-year LCR of 95% using a regimen of 60–66 Gy in 3 fr (13), and Rowe et al reported a 2-year LCR of 94% with a BED 10 ≥100 Gy, and 80% when BED 10 <100 Gy, (P=0.02) (34).…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic body radiotherapy for centrally‑located lung tumors with 56�Gy in seven fractions: A retrospective study

et al. 2018

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Stereotactic body radiotherapy (SBRT) for centrally-located lung tumors remains a challenge because of the increased risk of treatment-related adverse events (AEs), and uncertainty around prescribing the optimal dose. The present study reported the results of central tumor SBRT with 56 Gy in 7 fractions (fr) at the University of Tokyo Hospital. A total of 35 cases that underwent SBRT with or without volumetric-modulated arc therapy consisting of 56 Gy/7 fr for central lung lesions between 2010 and 2016 at the University of Tokyo Hospital were reveiwed. A central lesion was defined as a tumor within 2 cm of the proximal bronchial tree (RTOG 0236 definition) or within 2 cm in all directions of any critical mediastinal structure. Local control (LC), overall survival (OS), and AEs were investigated. The Kaplan-Meier method was used to estimate LC and OS. AEs were scored per the Common Terminology Criteria for Adverse Events Version 4.0. Thirty-five patients with 36 central lung lesions were included. Fifteen lesions were primary non-small cell lung cancer (NSCLC), 13 were recurrences of NSCLC, and 8 had oligo-recurrences from other primaries. Median tumor diameter was 29 mm. Eighteen patients had had prior surgery. At a median follow-up of 13.1 months for all patients and 18.3 months in surviving patients, 22 patients had died, ten due to primary disease (4 NSCLC), while three were treatment-related. The 1- and 2-year OS were 57.3 and 40.4%, respectively, and median OS was 15.7 months. Local recurrence occurred in only two lesions. 1- and 2-year LC rates were both 96%. Nine patients experienced grade ≥3 toxicity, representing 26% of the cohort. Two of these were grade 5, one pneumonitis and one hemoptysis. Considering the background of the subject, tumor control of our central SBRT is promising, especially in primary NSCLC. However, the safety of SBRT to central lung cancer remains controversial.

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“…In reports on SBRT of centrally located tumors, on the other hand, 2-year LCR ranges from 60 (29) to 94% (30). This is thought to be related to the lower BED 10 used to avoid severe AEs.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for centrally‑located lung tumors with 56�Gy in seven fractions: A retrospective study

et al. 2018

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“…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.…”

Section: Prescribed Dose Normal Tissue Constraintsmentioning

confidence: 99%

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

Adebahr¹,

Collette²,

Shash³

et al. 2015

BJR

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Evidence supports stereotactic body radiotherapy (SBRT) as a curative treatment option for inoperable early stage nonsmall-cell lung cancer (NSCLC) resulting in high rates of tumour control and low risk of toxicity. However, promising results are mainly derived from SBRT of peripheral pulmonary lesions, whereas SBRT for the central tumours can lead to severe radiation sequelae owing to the spatial proximity to the serial organs at risk. Robust data on the tolerance of mediastinal structures to high-dose hypofractionated radiation are limited; furthermore, there are many open questions regarding the efficiency, safety and response assessment of SBRT in inoperable, centrally located early stage NSCLC, which are addressed in a prospective multicentre study [sponsored by the European Organization for Research and Treatment of Cancer (EORTC 22113-08113-LungTech)]. In this review, we summarize the current status regarding SBRT for centrally located early stage NSCLC that leads to the rationale of the LungTech trial. Outline and some essential features of the study with focus on a summary of current experiences in dose/fraction-toxicity coherences after SBRT to the mediastinal structures that lead to LungTech normal tissue constraints are provided.Stereotactic body radiotherapy (SBRT) is a technique in which high doses of radiotherapy are very precisely delivered with steep dose gradients and a short overall treatment time (OTT). This achieves a very high biological dose.1 Evidence supports SBRT as a curative treatment option for inoperable early stage non-small-cell-lung cancer (NSCLC).2-5 Highprecision, hypofractionated dose delivery enables a significant reduction in both target volume size and exposure of normal tissue (NT) to high doses, resulting in a decreased toxicity risk and high rates of local control.6-8 However, promising results are mainly derived from the SBRT of small peripheral pulmonary lesions with low risk of treatment-related toxicity, as these tumours are surrounded by parallel organs at risk (OARs), specifically lung tissue. In contrast, the SBRT for central tumours can lead to severe, potentially life-threatening radiation sequelae owing to the spatial proximity to serial OARs. As robust, prospective and multicentre data on the tolerance of mediastinal structures to high-dose hypofractionated radiation is limited, there is generally caution in implementing SBRT for central lung tumours. Current published data are rather inconsistent regarding the definition of "central tumour", SBRT techniques, dose prescription and reporting, calculation algorithms, image guidance and evaluation of outcome. A recent systematic review has summarized the current limited evidence on this topic, mainly from singlecentre experiences, 9 but there are still many open questions

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“…For normal tissues, the use of a high dose per fraction rather than a conventional fractionated dose can increase the risk of late complications if the same volume were irradiated [67]. To date, only a few studies have reported on the safety and efficacy of treating centrally located lung tumors with SBRT [68–70]. In a group of 63 patients with centrally located lung tumors, Haasbeek et al reported that a total of seven patients developed grade 3 acute or late toxicity after undergoing eight fractions of 7.5 Gy [71].…”

Section: Resultsmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Small Lung Tumors in the University of Tokyo Hospital

Yamashita

Takahashi

Haga

et al. 2014

BioMed Research International

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Our work on stereotactic body radiation therapy (SBRT) for primary and metastatic lung tumors will be described. The eligibility criteria for SBRT, our previous SBRT method, the definition of target volume, heterogeneity correction, the position adjustment using four-dimensional cone-beam computed tomography (4D CBCT) immediately before SBRT, volumetric modulated arc therapy (VMAT) method for SBRT, verifying of tumor position within internal target volume (ITV) using in-treatment 4D-CBCT during VMAT-SBRT, shortening of treatment time using flattening-filter-free (FFF) techniques, delivery of 4D dose calculation for lung-VMAT patients using in-treatment CBCT and LINAC log data with agility multileaf collimator, and SBRT method for centrally located lung tumors in our institution will be shown. In our institution, these efforts have been made with the goal of raising the local control rate and decreasing adverse effects after SBRT.

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Stereotactic Body Radiotherapy for Lung Tumors at the Pulmonary Hilum

Abstract: SBRT for lung tumors located in the pulmonary hilar region may be tolerable and acceptable, if multiple treatments to the same major bronchus are avoided, and irradiated volumes are carefully taken into consideration.

Cited by 53 publications

References 35 publications

Stereotactic body radiotherapy for centrally‑located lung tumors with 56�Gy in seven fractions: A retrospective study

Stereotactic body radiotherapy for centrally‑located lung tumors with 56�Gy in seven fractions: A retrospective study

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

Stereotactic Body Radiotherapy for Small Lung Tumors in the University of Tokyo Hospital

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