Stereotactic Radiotherapy for Centrally Located Early-Stage Lung Tumors

Hypofractionated radical radiotherapy in elderly patients with medically inoperable stage I–II non-small-cell lung cancer

“…These authors state that 60 and 66 Gy delivered in three fractions were inappropriate for centrally located tumors. Although some aspects of this study were criticized [22] clear evidence was that for GTV volumes ≥10 cm 3 there were an increased risk of high grade toxicity irrespective of tumor localization. Zimmermann [23] found 19.2% of subjects with grade II lung sequeale later than 12 months with a median PTV of 79 cm 3 .…”

Complications from Stereotactic Body Radiotherapy for Lung Cancer

“…Therefore, centrally located tumors require modulation of the dose size and/or fractionation to allow for safe delivery without increased toxicity [ 97 ]. Less intensive fractionation schemes for SBRT or risk-adapted approaches have been advocated regardless of tumor location within the chest [ 44 , 56 , 103 , 105 , 106 , 107 , 108 ]. Currently, 50 Gy delivered over five fractions has been widely adopted for the treatment of centrally located tumors [ 22 , 109 ], although more protracted and presumably safer regimens have been explored by several institutions [ 90 , 97 , 110 ].…”

Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study

“…The largest clinical experience published thus far did not exclude any patient on the basis of poor lung function [ 26 ], and did not observe excessive lung toxicity when 'risk-adapted' SRT schemes were used This is supported by 2 recent reviews [ 40 , 41 ]. A report by Timmerman [ 42 ] which suggested that toxicity rates were high for central tumors treated with SRT has been criticized on the grounds of the toxicity definitions used [ 43 ].…”