Abstract
Purpose/objectives
Stereotactic body radiation therapy for centrally located lung tumors has been associated with increased risk of toxicity. A current study aims to evaluate tumor control and toxicity in large cohort of centrally located lesions.
Methods
Central location was defined as tumors within 2 cm of the bronchial tree, trachea, major vessels, esophagus, heart, pericardium, brachial plexus, or vertebral body. Tumors were biopsy proven or PET positive and included recurrent or primary non-small cell lung cancer (NSCLC). A dose was prescribed to a non-uniform planning target volume based on the internal tumor volume constructed from a 4D CT scan allowing for tumor motion. The treatment plans consisted of non-coplanar static aperture arcs and non-coplanar static fields. Treatments were delivered using 6MV X-rays with image guidance.
Results
At a median follow-up of 12.3 months, 107 total NSCLC tumors were retrospectively reviewed. A cohort consisted of primary (n = 57) and recurrent (n = 50) NSCLC tumors with subset of recurrent lesions including 27 hilar or mediastinal lymph nodes. Median and most frequent dose were 45 Gy in four fractions treated once weekly. Estimated 2-year Kaplan-Meier survival was 81.7%, with a significant survival advantage between primary and recurrent (p = 0.003). Eleven patients failed locally giving a 2-year actuarial local control rate of 80.7%, with control rates of 82.5 and 79.2% for primary and recurrent tumors, respectively (p = 0.828). Regional control at 2 years was not significantly different for primary (72.6%) and recurrent (62.7%). Analysis of toxicity revealed no grade 4 or 5 events. One grade 3 event was reported as pneumonitis. Grade 2 toxicity occurred in 10 patients, including dyspnea (1), chest wall pain (2), pneumonitis (4), rib fracture (1), and cough (2).
Conclusions
Moderate prescription dosing, treated once weekly, offers acceptable local control rates for centrally located tumors including recurrent mediastinal and hilar lymph nodes. Toxicity was minimal with the majority of patients experiencing no treatment-related adverse events.
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References
Fakiris AJ, McGarry RC, Yiannoutsos CT et al (2009) Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys 75(3):677–682
Timmerman R, Paulus R, Galvin J et al (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303(11):1070–1076
Shirvani SM, Jiang J, Chang JY et al (2012) Comparative effectiveness of 5 treatment strategies for early-stage non-small cell lung cancer in the elderly. Int J Radiat Oncol Biol Phys 84(5):1060–1070
Chang JY, Senan S, Paul MA et al (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 16(6):630–637
Timmerman R, McGarry R, Yiannoutsos C et al (2006) Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 24(30):4833–4839
Chang JY, Dong L, Liu H et al (2008) Image-guided radiation therapy for non-small cell lung cancer. J Thorac Oncol 3(2):177–186
Chang JY, Li QQ, Xu QY et al (2014) Stereotactic ablative radiation therapy for centrally located early stage or isolated parenchymal recurrences of non-small cell lung cancer: how to fly in a no fly zone. Int J Radiat Oncol Biol Phys 88(5):1120–1128
Senthi S, Haasbeek CJ, Slotman BJ, Senan S (2013) Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review. Radiother Oncol 106(3):276–282
Radiation therapy oncology group. Seamless phase I/II study of stereotactic lung radiotherapy (SBRT) for early stage, centrally located, non-small cell lung cancer (NSCLC) in medically inoperable patients. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study+=0813. Updated 6/8/2015. Accessed 23 Sep 2015
Bezjak A, Papiez L, Bradley J, Gore E, Gaspar L, Kong, MD, Feng-Ming Spring Phoenix (2012) Radiation therapy/NRG oncology group RTOG 0813 seamless phase I/II study of stereotactic lung radiotherapy (SBRT) for early stage, centrally located, non-small cell lung cancer (NSCLC) in medically inoperable patients. Update
Nagata Y, Hiraoka M, Mizowaki T, Narita Y, Matsuo Y, Norihisa Y, Onishi H, Shirato H (2009) Survey of stereotactic body radiation therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group. Int J Radiat Oncol Biol Phys 75(2):343–347
Corradetti MN, Haas AR, Rengan R (2012) Central-airway necrosis after stereotactic body-radiation therapy. N Engl J Med 366(24):2327–2329
US department of health and human services. National institutes of health. National cancer institute. Common terminology criteria for adverse events (CTCAE). (V4.03). http://evs.nci.nih.gov/ftp1/CTCAE/About.html. Published 2010–6-14. Updated 2010. Accessed 18 Sep 2015
Modh A, Rimner A, Williams E et al (2014) Local control and toxicity in a large cohort of central lung tumors treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 90(5):1168–1176
Davis JN, Medbery C, Sharma S et al (2015) Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch® patient registry. Radiat Oncol 10(1):113 015-0417-5
Park H, Harder E, Mancini B et al (2015) Central versus peripheral tumor location: influence on survival, local control, and toxicity following stereotactic body radiotherapy for primary non-small-cell lung cancer. JThorac Oncol 10(5):832–837
Schanne DH, Nestle U, Allgauer M et al (2015) Stereotactic body radiotherapy for centrally located stage I NSCLC: a multicenter analysis. Strahlenther Onkol 191(2):125–132
Milano MT, Chen Y, Katz AW, Philip A, Schell MC, Okunieff P (2009) Central thoracic lesions treated with hypofractionated stereotactic body radiotherapy. Radiother Oncol 91(3):301–306
Onishi H, Araki T, Shirato H et al (2004) Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 101(7):1623–1631
Oshiro Y, Aruga T, Tsuboi K et al (2010) Stereotactic body radiotherapy for lung tumors at the pulmonary hilum. Strahlenther Onkol 186(5):274–279
Chang JY, Balter PA, Dong L et al (2008) Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 72(4):967–971
Rowe BP, Boffa DJ, Wilson LD, Kim AW, Detterbeck FC, Decker RH (2012) Stereotactic body radiotherapy for central lung tumors. J Thorac Oncol 7(9):1394–1399
Nuyttens JJ, van der Voort van Zyp NC, Praag J et al (2012) Outcome of four-dimensional stereotactic radiotherapy for centrally located lung tumors. Radiother Oncol 102(3):383–387
Bral S, Gevaert T, Linthout N et al (2011) Prospective, risk-adapted strategy of stereotactic body radiotherapy for early-stage non-small-cell lung cancer: results of a phase II trial. Int J Radiat Oncol Biol Phys 80(5):1343–1349
Inoue T, Shiomi H, Oh RJ (2015) Stereotactic body radiotherapy for stage I lung cancer with chronic obstructive pulmonary disease: special reference to survival and radiation-induced pneumonitis. J Radiat Res 56(4):727–734
Radiation therapy oncology group. A randomized phase II study comparing 2 stereotactic body radiation therapy (SBRT) schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study+=0915. Updated 2014. Accessed 9 Sep 2015
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John Bowers declares he was previously employed by the Riverside Regional Medical Center. Nathan Bennion declares he was previously employed by the Riverside Regional Medical Center. Martin Richardson declares that he is a current employee of the Riverside Regional Medical Center. Kelly Spencer declares that he is a current employee of the Riverside Regional Medical Center. James Larner declares that he is a faculty member of the Department of Radiation Oncology, University of Virginia Cancer Center. Ronald Kersh declares that he is a faculty member of the Department of Radiation Oncology, University of Virginia Cancer Center, and employed by the Riverside Regional Medical Center.
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Bowers, J., Bennion, N.R., Richardson, M. et al. Stereotactic body radiation therapy (SBRT) for centrally located primary and recurrent non-small cell lung cancer (NSCLC): analysis of toxicity and local control. J Radiat Oncol 6, 247–253 (2017). https://doi.org/10.1007/s13566-016-0289-9
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DOI: https://doi.org/10.1007/s13566-016-0289-9