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Specific toxicity after stereotactic body radiation therapy to the central chest

A comprehensive review

Spezifische Toxizität nach stereotaktischer Strahlentherapie des zentralen Brustkorbs

Eine umfangreiche Literaturübersicht

  • Review Article
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Strahlentherapie und Onkologie Aims and scope Submit manuscript

“The results show that the effect of multiple dose fractions, even a very small one, is in no respect different, in terms of macroscopic (skin) damages, from that of a single dose” Reisner, “Skin erythema and roentgen therapy”, 1933

Abstract

The toxicity of stereotactic body radiation therapy in the central chest remains an unsettled issue. The collected data concerning the observed complications are poorly understood and are limited in their quantity and quality, thus hampering a precise delineation of treatment-specific toxicity. The majority of complications scored as toxicity grade 5, namely respiratory failure and fatal hemoptysis, are most likely related to multiple competing risks and occurred at different dose fractionation schemas, e. g., 10–12 fractions of 4–5 Gy, 5 fractions of 10 Gy, 3 fractions of 20–22 Gy, and 1 fraction of 15–30 Gy. Further investigations with longer follow-up and more details of patients’ pretreatment and tumor characteristics are required. Furthermore, satisfactory documentation of complications and details of dosimetric parameters, as well as limitation of the wide range of possible fractionation schemes is also warranted for a better understanding of the risk factors relevant for macroscopic damage to the serially organized anatomic structure within the central chest.

Zusammenfassung

Das Risiko für schwere Nebenwirkungen der stereotaktischen Strahlentherapie bei zentralen Lungentumoren ist bisher schlecht definiert. Nicht nur die begrenzte Zahl der dokumentierten Ereignisse, sondern auch die Vielzahl der verwendeten Fraktionierungsschemata erschwert das Herausarbeiten valider prognostischer Faktoren. Auf Basis dieser Datenlage lässt sich das Risiko für Grad-5-Toxizitäten, insbesondere Atemversagen und tödliche Blutungen, kaum einem bestimmten Dosis- oder Fraktionierungsschema, wie z. B. 10–12 Fraktionen mit 4–5 Gy, 5 Fraktionen mit 10 Gy, 3 Fraktionen mit 20–22 Gy und 1 Fraktion mit 15–30 Gy zuordnen, da multiple patientenspezifische, konkurrierende Risiken dabei einen wesentlichen Einfluss zu haben scheinen. Es wird zukünftig erforderlich sein, prätherapeutische Patienten- und Tumorcharakteristika genauer zu erfassen, dosimetrische Parameter besser zu dokumentieren und die Vielfalt der Fraktionierungsschemata zu begrenzen, um die relevanten Risikofaktoren für schwere Nebenwirkungen an den seriell organisierten anatomischen Strukturen des zentralen Brustkorbs besser definieren zu können.

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Authors and Affiliations

  1. Department of Radiation Oncology, Alb-Fils Kliniken GmbH, Eichertstr. 3, 73035, Goeppingen, Germany

    Feras Oskan,  Gerd Becker &  Martin Bleif

  2. Radiochirurgicum, CyberKnife Suedwest Centre, Eichertstr. 3, 73035, Goeppingen, Germany

    Feras Oskan,  Gerd Becker &  Martin Bleif

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Correspondence to Feras Oskan.

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F. Oskan, G. Becker, and M. Bleif declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Oskan, F., Becker, G. & Bleif, M. Specific toxicity after stereotactic body radiation therapy to the central chest. Strahlenther Onkol 193, 173–184 (2017). https://doi.org/10.1007/s00066-016-1063-z

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