Stereotactic body radiotherapy of central lung malignancies using a simultaneous integrated protection approach

A prospective observational study
  • Rosario MazzolaEmail author
  • Ruggero Ruggieri
  • Vanessa Figlia
  • Michele Rigo
  • Niccolò Giaj Levra
  • Francesco Ricchetti
  • Luca Nicosia
  • Stefanie Corradini
  • Filippo Alongi
Original Article



It is recognized that stereotactic body radiotherapy (SBRT) for centrally located lung metastases is affected by higher rates of severe toxicity. In the present study, we report the clinical outcomes following a novel intensity-modulated radiotherapy prescription dose, termed simultaneous integrated protection (SIP), for nearby organs at risk (OARs).

Materials and methods

The prescribed total doses of SBRT were 70 Gy in 10 fractions and 60 Gy in 8 fractions. For ultra-centrally located lesions, a dose of 60 Gy in 10 fractions was delivered. The main planning instructions were: (1) to remain within the limits of the given dose constraints for an OAR; (2) to make use of the maximum possible dose to the OARs to minimize dose inhomogeneity for the Planning Target Volume (PTV). SBRT-related toxicity was prospectively assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. The primary clinical endpoint was the SBRT-related toxicity. Secondary endpoint was local control.


Forty patients affected by a single central malignancy were analyzed. The median follow-up was 20 months (range, 6–58 months). Acute and late clinical pulmonary toxicity ≥grade 2 was recorded in 2 out of 40 patients (5%) and 3 out of 40 patients (7%), respectively. No patient experienced cardiac toxicity. No narrowing or stenosis of any airway or vessel was registered. One-year local control rate was 91%. The median time to local progression was 13 months (range, 6–46 months).


SBRT using a PTV-SIP approach for single central lung metastases achieved low SBRT-related toxicity with acceptable local control.


Lung malignancies Radioterapy Oligometastases Toxicity Lung tumor 

Stereotaktische Bestrahlung zentraler Lungenmaligome mit simultan integrierter Protektion (SIP) von Risikoorganen

Eine prospektive Beobachtungsstudie



Die extrakranielle Körperstereotaxie (SBRT) von zentral gelegenen Lungentumoren weist höhergradige Toxizitäten auf. In der vorliegenden Studie berichten wir über die klinischen Ergebnisse einer neuen intensitätsmodulierten Technik, welche zur Reduktion der Toxizität eine simultan integrierte Protektion (SIP) von Risikoorganen (OARs) anwendet.

Material und Methoden

Die Verschreibungsdosis der SBRT war 70 Gy in 10 Fraktionen und 60 Gy in 8 Fraktionen. Bei sehr zentral gelegenen Läsionen wurde eine Dosis von 60 Gy in 10 Fraktionen appliziert. Die wichtigsten Punkte bei der Bestrahlungsplanung waren folgende: (1) innerhalb der Toleranzgrenzen der OAR zu bleiben; (2) die maximale Dosis eines OARs auszureizen, um die Dosisinhomogenität für das PTV zu minimieren. Die therapiebezogene Toxizität wurde prospektiv nach den Common Terminology Criteria for Adverse Events (CTCAE) v4.0 erhoben. Der primäre klinische Endpunkt war die SBRT-bezogene Toxizität. Sekundärer Endpunkt war die lokale Kontrolle.


Insgesamt wurden 40 Patienten an einem singulären zentralen Lungentumor behandelt. Das mediane Follow-up betrug 20 Monate (Spanne 6–58 Monate). Akute pulmonale Nebenwirkungen ≥Grad 2 wurden bei 2 von 40 Patienten (5%) festgestellt und pulmonale Spätnebenwirkungen (≥Grad 2) bei 3 von 40 Patienten (7%). Kein Patient wies eine kardiale Toxizität auf. Es wurde keine Verengung oder Stenose der Atemwege oder Gefäße festgestellt. Die lokale 1‑Jahres-Kontrollrate lag bei 91%. Die mediane Zeit bis zum lokalen Progress betrug 13 Monate (Spanne 6–46 Monate).


Eine SBRT unter Verwendung eines PTV-SIP-Ansatzes für zentrale Lungenmalignome ermöglicht eine akzeptable lokale Tumorkontrolle bei niedriger therapieassoziierter Toxizität.


Lungenmalignome Strahlentherapie Oligometastasen Toxizität Lungentumor 


Compliance with ethical guidelines

Conflict of interest

R. Mazzola, R. Ruggieri, V. Figlia, M. Rigo, N.G. Levra, F. Ricchetti, L. Nicosia, S. Corradini, and F. Alongi declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rosario Mazzola
    • 1
    Email author
  • Ruggero Ruggieri
    • 1
  • Vanessa Figlia
    • 1
  • Michele Rigo
    • 1
  • Niccolò Giaj Levra
    • 1
  • Francesco Ricchetti
    • 1
  • Luca Nicosia
    • 1
  • Stefanie Corradini
    • 2
  • Filippo Alongi
    • 1
    • 3
  1. 1.Radiation OncologyIRCCS, Sacro Cuore-Don Calabria HospitalNegrar-VeronaItaly
  2. 2.Radiation OncologyLMU MunichMunichGermany
  3. 3.University of BresciaBresciaItaly

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