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Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy

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Abstract

Introduction

The use of Stereotactic Body Radiotherapy (SBRT) is controversial in Ultra-Central lung tumors, a subset of central lung tumors characterized by proximity to critical mediastinal structures. This is of interest in oligometastatic (≤3 metastases) patients, who can yield survival benefit from local treatments. The aim of our study is to assess the determinants of efficacy and toxicity in this setting.

Materials and methods

Clinical and dosimetric parameters were reviewed in a cohort of oligometastatic patients treated with SBRT for ultra-central tumors. Local control rate (LC) and toxicity were assessed. Statistical Analysis was carried out to assess the impact of those predictors on local recurrence and adverse events.

Results

One-hundred-nine consecutive patients were included. A median Biologic Effective Dose (BED) of 105 (75–132) Gy10 was prescribed. At a median follow-up of 17 (range 3–78) months, 2-year LC was 87%. Improved LC was correlated to Planning Treatment Volume (PTV) covered by 95% of the prescription dose (V95% PTV) > 85% (HR 0.15, 95%CI 0.05–0.49, p = 0.0017) and to Gross Tumor Volume (GTV) < 90 cm3 (HR 0.2, 95%CI 0.07–0.56, p = 0.0021). Overall and grade ≥ 3 toxicity incidence was 20% and 5%, respectively. Patients experiencing acute and late toxicities received significantly higher dose to 1 cm3 (D1cm3) of esophagus and lung volume receiving ≥5 Gy (V5Gy) (p = 0.016 and p = 0.013), and higher dose to 0.1 cm3 (D0.1cm3) of heart (p = 0.036), respectively.

Conclusion

V95% PTV > 85% and GTV < 90 cm3 are independent predictors of LC. Dose to esophagus, lung and heart should be carefully assessed to minimize treatment-related toxicities.

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Authors and Affiliations

  1. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy

    Mauro Loi, Davide Franceschini, Ilaria Chiola, Ciro Franzese, Giuseppe Roberto D’Agostino, Piera Navarria, Marco Marzo, Lucia Paganini, Tiziana Comito, Pietro Mancosu, Stefano Tomatis, Luca Cozzi & Marta Scorsetti

  2. Radiotherapy Department, University of Florence, Florence, Italy

    Luca Dominici

  3. Thoracic Surgery Department, Hopital Cochin, Université Paris Decartes, Paris, France

    Marco Alifano

  4. Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Area, Italy

    Ciro Franzese, Luca Cozzi & Marta Scorsetti

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  1. Mauro Loi
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Contributions

All authors contributed to the conception and design of the retrospective study as well as data acquisition, analysis, and interpretation. All authors were involved in drafting and revising the manuscript. All authors have given their approval for the submission of this manuscript.

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Correspondence to Mauro Loi.

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Conflict of interest

M. Loi, D. Franceschini, L. Dominici, I. Chiola, C. Franzese, G.R. D’Agostino, P. Navarria, M. Marzo, L. Paganini, T. Comito, P. Mancosu, S. Tomatis, L. Cozzi, M. Alifano, and M. Scorsetti declare that they have no competing interests.

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Supplementary Material: Dose constraints for organs at risk, detailed statistical analysis for outcome and related figures

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Loi, M., Franceschini, D., Dominici, L. et al. Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy. Strahlenther Onkol 197, 396–404 (2021). https://doi.org/10.1007/s00066-020-01687-9

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